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A HANDBOOK FOR SCHOOL NUUSES 



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THE MACMILLAN COMPANY 

NEW YORK • BOSTON • CHICAGO • DALLAS 
ATLANTA • SAN FRANCISCO 

MACMILLAN & CO., Limited 

LONDON • BOMBAY • CALCUTTA 
MELBOURNE 

THE MACMILLAN CO. OF CANADA, Ltd. 

TORONTO 



A HANDBOOK 
FOE SCHOOL NURSES 



BY 



HELEN W. KELLY, R.N. 

SUPEKIKTENDBNT OF FIELD NURSES 

DEPARTMENT OF HEALTH 

CHICAGO, ILL. 



AND 

MABEL C. BRADSHAW, R.N. 

SUPERINTENDENT OF SCHOOL NURSES 

BOARD OF EDUCATION 

MILWAUKEE, WIS. 



THE MACMILLAN COMPANY 
1918 

All rights reserved 






COPTBIOHT, 1918, 

bt the macmillan company. 



Set up and electrotyped. Published April, 19x8. 



» » 

* 



MRR 27 1918 



J. S. Gughing Co. — Berwick dk Smith Go. 
Norwood, Mass., U,S.A. 



©CI.A494338 



To nurses everywhere, who, by their initiative, persever- 
ance, and enthusiasm, have made possible the success of 
medical inspection of school children ; who have been willing 
to embark, without guidance, on an entirely new venture; 
who have had the vision to see its possibilities, ana the faith 
to persevere in the face of great obstacles ; who have made 
up with enthusiasm and optimism what they lacked in the 
way of special preparation for the work — to these women 
this little book is dedicated with sincerest appreciation. 



FOREWORD 

With the increasing demand for School Nurses 
throughout the country, comes a corresponding 
demand for information as to how best to organize 
and carry on the work; and directors and nurses 
turn for advice to the larger cities wher^ the work 
has passed the experimental stage, and where 
definite programs have been worked out. 

As directing heads of established systems of 
school nursing, the writers are constantly being 
caiUed upon to advise as to the methods of routine 
procedures, and to recommend literature; and it 
is with the hope of helping to supply this obvious 
need that we have prepared this outline of school 
nursing procedures as carried out in the schools of 
several cities in the Middle West. 

Grateful acknowledgment is made to Dr. G. P. 
Barth, Director of School Hygiene, Milwaukee; 
Mathilde H. Krueger, R.N., Neenah, Wis. ; Marie 
Peterson, R.N., LaCrosse, Wis. ; and Sadie B. 
Place, R.N., Civic Nurse, Kewanee, 111., for ma- 

vii 



Vlll FOREWORD 

terial on Community Nursing ; to Agnes J. Martin, 
R.N., Supervising Field Nurse, Chicago Department 
of Health, for much valuable assistance, and to 
Lauretta Heilegenthal, for untiring work on the 
manuscript. 



CONTENTS 



CHAPTER I 



PAGB 



Historical Sketch; Present Status; Future of School 

Nursing 1 

CHAPTER II 

Organization and Administration; The Nursing Staff; 

Uniforms; Ethics of School Nursing ... 7 

CHAPTER III % 

Plan and Character of Work; Prevention of Contagion; 
Preliminary Inspections — Routine Inspections — 
Emergencies — Physical Examinations — Vaccinations 
— Cultures ; Dressings ; Treatment of Minor Conta- 
gious Diseases ; Home Calls ; Dispensaries ; Hospitals ; 
A Typical Day's Work 28 

CHAPTER IV 

Educational Work : Routine Talks — Health Leagues — 

Boys' Clubs — Parent-Teacher Associations . . 51 

CHAPTER V 

Special Features : Dental Dispensaries — Toothbrush DriUs 
— Fresh Air Schools — Diet Lists — Cooperating Agen- 
cies — The School Nurse as an Attendance Officer . 67 

CHAPTER VI 

Community Nursing ; Problems — Survey — Confer- 
ences — Home Calls — Correction of Physical Defects 88 

CHAPTER VII 

Records: The Importance of Complete Records — 

Forms • .94 

12 



HAl^DBOOK FOR SCHOOL 

I^URSES 

CHAPTER I 

HISTORICAL SKETCH; PRESENT STATUS; FUTURE 
OF SCHOOL NURSING 

Medical Inspection of schools, or what is per- 
haps a better term — Health Supervision of School 
Children — was begun in France about the middle 
of the last century, and spread rapidly in all en- 
lightened countries, as people more and more have 
been brought to realize that the welfare of the 
children means the welfare of the nation. Since 
its introduction into the United States in 1894, 
twenty-six states have passed laws making medical 
inspection of schools statewide in its application, 
and it is probably carried on to some extent in all 
states, even though there is no compulsory law. 
In twenty of the states having compulsory medical 
inspection the authority for administering the law 
is vested in boards of education. 

B 1 



2 HANDBOOK FOR SCHOOL NURSES 

School nursing is the natural outgrowth of this 
medical inspection of school children, which re- 
sulted in the exclusion from school of many children 
with minor contagious diseases, particularly skin 
affections, and pediculosis. The majority of these 
children received no treatment at home; were 
allowed to run about the streets, infecting other 
children, and forming habits of truancy ; losing, 
moreover, the opportunity for continuous, system- 
atic school work. 

It soon became apparent that medical inspection 
must be carried further than the detection and exclu- 
sion of children suffering from contagious diseases 
or physical defects, if it was to justify its introduc- 
tion into the school system ; and school authorities 
began to cast about for a solution of the problem. 
As so often happens, while the problem was growing 
in size and complexity, the solution was uncon- 
sciously and unobtrusively developing close at hand. 
Visiting nurses had for some time been doing volun- 
teer work in the schools of London and Liverpool, 
following into the schools, children from families 
in which contagious conditions were found and giv- 
ing them the required attention. This work was 
brought to the notice of Miss Honnor Morton, who 
had served a year as a "lady probationer" in one 



HISTORICAL SKETCH 3 

of the hospitals of London, and was at this time a 
member of the School Board of that city. She 
urged the employment of nurses to follow into their 
homes, the children excluded from school; to see 
that their ailments received attention, and that the 
children were returned to school at the earliest 
possible moment. That her recommendation was 
accepted is shown by the fact that a staff of school 
nurses was appointed in London in 190L 
' In the United States the introduction of nurses 
into the schools was due to the public% spirit and 
breadth of vision of a woman who has rendered 
conspicuous service to public health in this country. 
Miss Lillian Wald of the Nurses Settlement, Henry 
Street, New York, lent a nurse from her staff to demon- 
strate the value of school nursing. This nurse. Miss 
Lina Rogers — now Mrs. W. E. Struthers of To- 
ronto — proved so conclusively that the nurse is the 
logical medium of communication between the school 
and the home, that the city authorities in 1903 ap- 
pointed a staff of nurses for this work. 

In Chicago the work was inaugurated by the 
Visiting Nurse Association, with the result that the 
city authorities were so convinced of the need for 
nurses in the schools, as to appropriate money for 
their salaries, and later to take over the work as a 



4 HANDBOOK FOR SCHOOL NURSES 

part of the activities of the Bureau of Medical 
Inspection, of the Department of Health. 

Chicago gives the same care to the children in 
parochial and other private schools as to those in 
the public schools. 

Credit for starting this work in Milwaukee be- 
longs to Mrs. Francis Boyd, President of the Visit- 
ing Nurse Association, who in 1908 asked, and re- 
ceived, permission from the Superintendent of 
Schools to have nurses from the Visiting Nurse 
staff visit the schools in the congested districts. 
The work was carried on by the Visiting Nurse 
Association imtil 1916 when it was taken over 
by the Board of Education. 

These instances are cited to illustrate different 
systems of organization and administration; and 
to acknowledge the debt to private organizations 
and individuals, for initiating the work and so 
forcibly demonstrating its importance, that munici- 
pal and county authorities were willing to appro- 
priate the necessary funds for its continuance. 
They also serve to show the importance — to the 
nurse organizing public health work in any locality 
— of enlisting the aid of women^s organizations, 
and of public spirited men and women in the com- 
munity. 



HISTORICAL SKETCH 5 

The Future of School Nursing 
It requires no prophetic vision to foresee a rapidly- 
extending field of activity for the school nurse. 
Already she is being consulted by teachers and 
parents on many matters of health and welfare 
which do not come strictly within the limits of her 
office; and by a slight stretch of the imagination, 
we can see her in the near future, known, not as 
the school nurse, but as the Director of School 
Hygiene, charged with the responsibiHty for all 
the health conditions of the school; v^tilation, 
heating, lighting, etc. ; as lecturer on hygiene and 
physiology ; and as general health advisor of the 
whole school population. 

If the subject of social hygiene is to be taught 
in the schools, it must be taught by one who has 
the necessary medical and biological knowledge, 
and who, at the same time, possesses the confi- 
dence of the children. This combination is foimd, 
ready to hand, in the person of the school nurse, 
who is even now constantly being called upon to 
give information on^his subject to individual girls 
in the schools. 

The last report of the Commissioner of Educa- 
tion (1915) shows the number of cities having school 
nurses to be 268. 



6 HANDBOOK FOR SCHOOL NURSES 

Total number of nurses reported, 923. 

Cities where nurses are employed by Board of 
Education, 174. 

Cities where nurses are employed by Board of 
Health, 43. 

Cities where nurses are employed by other agen- 
cies, 36. 

Cities having dental clinics for school children, 
130. 

Cities treating teeth of school children, 195. 

Cities where treatment is paid for by Board of 
Education, all or in part, 42. 

Cities where treatment is paid for by Board of 
Health, 4. 

Cities where treatment is free, or paid for by 
city, county, or other agencies, 89. 

Cities having psychological clinics under expert 
direction, 33. 

Cities having a central or general clinic, 74. 



CHAPTER II 

ORGANIZATION AND ADMINISTRATION ; THE 
NURSING STAFF; UNIFORMS; ETHICS OF SCHOOL 

NURSING 

There is considerable diversity of opinion as to 
what agency in a community should direct the 
work of medical inspection of school children. 
No hard-and-fast rule can be laid down 'Por this, 
as in one community the Board of Education might 
be the logical administering agency, in another 
the Board of Health, while in a third the work 
might be much more wisely carried on by a private 
organization, such as a Visiting Nurse Association, 
or a Women's Club. The important thing is to 
place it imder the direction of that local organiza- 
tion which is least hampered by political, or other 
retarding influence. 

The principal argument advanced in favor of 
control by Boards of Education is that it makes 
for unification of administration in the schools; 
while the advocates of Board of Health super- 
vision maintain that school boards, being usually 

7 



8 handbook; foe school nurses 

composed of lay men and women^ cannot get the 
medical viewpoint, which is so essential for the 
proper direction of health matters, and that as 
Boards of Health are charged with the responsi- 
bility of the health of the community at all times, 
they should not relinquish the supervision of the 
child during the years when he is most susceptible 
to contagions of various kinds, when physical 
defects are most liable to aggravation by unhygienic 
surroundings, and when these defects respond most 
readily to treatment. 

Where local conditions point to the Board of 
Education as the logical administrator of medical 
inspection, the physician or nurse in charge should 
be ex-officio a member of the school board. 

When health supervision is carried on by the 
Department of Health, the question of parochial 
and other private schools is more likely to receive 
attention than when the work is done under the 
direction of the Board of Education. Moreover, 
medical supervision of school children, being a 
fundamental part of community health, would 
seem logically to be a function of the Department 
whose business it is to safeguard the health of the 
community. On the other hand, there can be no 
doubt that having all the school activities under 



ORGANIZATION AND ADMINISTRATION 9 

one administrative body makes for greater har- 
mony and saves time and energy. 

There are several systems of medical inspection 
in force in different communities, as follows : 

1. Examination of vision and hearing by teachers. 

2. Examination for contagious diseases only, by 
physicians. 

3. Examination for contagious disease and physical 
defects by physicians, with follow-up work by nurses. 

4. Examination for contagious disease by physicians, 
with a preliminary examination for vision and hearing 
by teachers, and for other physical defects by physicians, 
with follow-up work by nurses. • 

5. Examination by nurses only. 

If we take up the different methods of medical 
inspection separately and study the results of the 
past, we shall see that with the first method where 
the teacher makes the examination for defects of 
vision or hearing, the results obtained have not been 
very satisfactory, because to many parents the 
mere notification that John or Mary does not see 
or hear well, seldom if ever meets with any response. 
Parents are often inclined to believe it is more 
inattention on the part of the child than a physical 
defect that interferes with progress in school; or 
the parent may not understand just what atten- 
tion should be given, or how it may be obtained; 



10 HANDBOOK FOR SCHOOL NURSES 

and the family physician's advice is seldom asked 
in what seems, to the parent, to be so simple a 
matter as a little deafness or near-sightedness. 

The second method, providing for '^examination 
for contagious diseases by physicians/' is only 
partial inspection, as it merely excludes the child 
from school, the doctor having no means of know- 
ing home conditions or how the child will be cared 
for at home. It is merely an exclusion to safe- 
guard the other children in school, and without 
the follow-up work of the nurse, results in much 
loss of time from school on the part of the child. 

The third method, an examination for contagious 
diseases and physical defects by the physician, 
with "follow-up" work by the nurse, is by far the 
most thorough as it provides prompt and intelli- 
gent care for the child suffering from contagious 
disease, and assures a speedy return to school on 
the termination of the illness. This plan also 
offers an opportunity to learn something of the 
home conditions of the child, and to determine 
whether or not he should be given free treatment. 

The fourth plan, a preliminary test for vision 
and hearing by the teacher, with examination for 
other physical defects and for contagious diseases 
by a physician, with follow-up work by nurses, has 



OEGANIZATION AND ADMINISTRATION 11 

disadvantages, as the teacher usually has too large 
a class, and too many other duties to permit her 
to take the time from her class work to make cor- 
rect eye and ear tests. 

The fifth method; employment of nurses only, is 
adopted in some places where the authorities feel 
that they cannot afford the services of both physician 
and nurse. A nurse may, and very many do, ac- 
complish a great deal working alone, still she is 
handicapped by the impossibility of receiving prompt 
diagnosis and prescription for children foimd to 
be suffering from physical defects, or suspect con- 
tagious disease. In communities where it is possible 
to employ but one medical worker for the schools, 
imquestionably that one should be a nurse rather 
than a physician, as the follow-up work, which is 
so important, will not be done if only a physician 
is employed. 

When the nurse is obliged to work alone, there 
should be one or more physicians to whom she may 
take children for consultation and advice; there 
should be, moreover, the closest cooperation with 
all the physicians and with the other constructive 
forces in the community if the nurse's work is to 
attain the highest possible standard of efficiency. 

Salaries : The salary of the school nurse varies 



12 HANDBOOK FOR SCHOOL NURSES 

with the locality in which she works. In the middle 
western states, seventy-five dollars ($75.00) per 
month is the minimum offered. Most commimities 
pay from eighty to one hmidred and ten dollars 
per month. 

Supervising nurses receive twelve hundred per 
year and upward. 

Public officials, and people in general, are be- 
ginning to learn that expert service is worth paying 
for, that the nurse who is willing to accept a low 
salary is often willing and prepared to do a cor- 
respondingly low type of work, and that only the 
best is good enough for the schools where our future 
citizenship is in the making. 

Vacations : The school nurse should have a 
vacation of at least one month with full pay. This 
vacation should not be taken in broken periods, 
but should be continuous, as only by a continued 
period of relaxation can the nurse renew her physical 
and mental energies. It would be best to rest 
during the entire school vacation and return in 
the autumn with fresh energy and enthusiasm for 
the work. 

The Nursing Staff 

No matter how small the staff, one nurse should 
be in charge and should be held responsible for 



OKGANIZATION AND ADMINISTRATION 13 

the work done, all the business of the nursing service 
being carried on through her office. Where the 
staff is large there should be, besides the Superin- 
tendent of Nurses, one Supervising Nurse for each 
fifteen or twenty nurses; each assigned to a definite 
district, held responsible for the work, and given 
sufficient authority to carry on the activities of 
the district without unnecessary delay. The in- 
struction and direction of the nurses, the planning 
of schedules, the grouping of schools, and the ad- 
justment of minor difficulties in the district, should 
be given over entirely to the District Supervisor, 
thus relieving the central office of a large amount 
of detail. 

The number of schools assigned to each nurse 
will depend on the character of the population, the 
size of the schools, the distance to be covered, the 
amount of work to be done, and man}^ other factors 
pecuHar to the local situation. In the congested 
districts of large cities a nurse should not attempt 
to care for more than 2500 to 3000 children. 

The Superintendent of Nurses 
The woman who would successfully direct a 
staff of school nurses must have, besides a sound 
academic and professional education, a broad knowl- 



14 HANDBOOK FOR SCHOOL NURSES 

edge of social conditions, and the many factors 
underlying and influencing those conditions. She 
must have an open, receptive mind, ever alert for 
suggestions for the improvement of the service ; and 
a keen sense of justice which will insure a ^^ square 
deal'^ for every member of the staff, and for all 
others with whom she may come in contact in the 
performance of her duties. As she must act as 
the medium of communication between the nursing 
staff and the directing body, she must be able to 
get the viewpoint of each, and to interpret each 
to the other. She must have a very definite ideal 
for her staff and must Jealously guard this ideal 
from all influences that might tend to lower it. 
She should be easily accessible to members of the 
nursing staff, to the school doctors, and to parents 
or teachers who may wish to consult her about the 
work in the schools. As it is important that she 
spend a fair amount of her time in the schools, it 
will be seen that only a wise arrangement of her 
time and the ability to delegate responsibility to 
others will enable the Superintendent of a large 
staff to successfully perform the duties required of 
her and still preserve her sense of proportion. 



ORGANIZATION AND ADMINISTRATION 15 



The Supervising Field Nurse 

The Supervising Field Nurse should be pro- 
moted from the ranks, for in no other way than 
by actual experience can she obtain an insight 
into the work which will enable her to fully ap- 
preciate all the problems which arise in the dis- 
trict, and the best methods to pursue in their solu- 
tion. 

She is held responsible for the work of the nurses 
in a certain territory, and is given a cor|;esponding 
authority in directing measures for the accomplish- 
ment of this work. To her falls the task of initiat- 
ing the new nurses, directing and encouraging them 
until they are able to "stand on their own feet.'' 
To her are referred all the problems arising in her 
district which are beyond the power of the school 
nurse to adjust, all cases which need the atten- 
tion of other relief agencies, and all matters of 
difference between the nurse and the school authori- 
ties. She must decide which matters should be 
adjusted in the district and which should be re- 
ported to the central office. 

To meet these many demands the Supervising 
Field Nurse needs a peculiar personality. She 
must be a woman of discretion, good judgment, 



16 HANDBOOK FOR SCHOOL NURSES 

and tact, with a thorough knowledge of nursing 
technic and ethics, the symptoms of contagious 
diseases, the local and state quarantine and sani- 
tary laws, the location and function of relief 
agencies, and a thorough understanding of the 
rulings of her own organization. Add to these a 
judicial mind, a keen sense of justice and fair play, 
the courage of her convictions, and a fund of opti- 
mism, and the nurse is well equipped for the re- 
sponsible position of Field Supervisor. 

The Field Nurse 

There is probably no other branch of nursing 
in which personality counts for so much as in the 
work of the school nurse. This factor, more than 
any other, will determine her success in school 
and home and her influence upon the lives and 
characters of the children intrusted to her care. 
Children are quick to imitate adults with whom 
they are closely associated, consequently one of 
the gravest responsibilities in placing a nurse in 
any school is to see to it that she is a woman who 
will exert the right influence on the children. 

On the judgment, good sense, initiative, and 
enthusiasm of the nurse will depend her standing 
in the schools and homes of her district. If she is 



ORGANIZATION AND ADMINISTRATION 17 

quick to recognize, and to meet new situations, she 
can often prevent misunderstanding and friction. 
A never failing optimism and a sense of humor 
are important if she is to guard against discourage- 
ment and preserve her sense of values. In addi- 
tion, she should have imagination and vision which 
will enable her to look beyond the confines of the 
present and see the results of her work in genera- 
tions yet unborn, and will reveal to her in the un- 
kempt child of the tenements the potential leader 
of the nation. 

Here, as in all other branches of nursing, the 
higher education counts for much, as the mind 
trained to reason quickly and accurately is a valu- 
able asset in school work ; furthermore, the educated 
woman recognizes the fact that no human mind 
can contain all knowledge and is glad to receive 
instruction in new lines of work. Add to this the 
atmosphere the cultured woman inevitably creates 
about her, and the importance of a good academic 
education is apparent. The professional training 
of the nurse should be of the best, as the qualities 
so essential to good work in the schools are obtained 
only by long experience under careful supervision, 
and if a thorough knowledge of surgical technic, 
the ability to recognize the symptoms of contagious 



18 HANDBOOK FOR SCHOOL NURSES 

diseases, a working knowledge of dietetics, — par- 
ticularly the feeding of children, — an appreciation 
of nursing ethics, and the faculty of prompt obe- 
dience, have not been acquired in her undergraduate 
days, the nurse is at a great disadvantage on taking 
up school nursing; moreover she places a heavy 
burden upon the teaching force of the staff, which 
must train her in the rudiments of nursing technic 
as well as in the technic of this special branch of 
the work, if she is to be of any value, and as it is 
usually impossible to give the time for this thorough 
training, the nm-se is advised to seek some other 
field of usefulness. When an ill-prepared nurse is 
selected to start school nursing in a community 
where she will work entirely on her own responsi- 
bility, the results are usually disastrous, she be- 
comes discouraged by the many problems which 
she does not know how to meet, and, laying the 
blame for her failure anywhere but on her own 
lack of preparation, she deserts the new venture 
which generally suffers a serious "set-back" in 
consequence of her inefficiency. 

Good health is an important factor in the equip- 
ment of the school nurse, as it will leave her free to 
concentrate her attention on the work in hand, with 
a minimum of consideration for her own welfare, 



OKGANIZATION AND ADMINISTRATION 19 

which will make it possible for her to be out in all 
kinds of weather without ill effects, and will fur- 
nish a basis for a well-balanced mind. The nurse 
who has done private duty or institutional work 
until she is worn out, and is looking for something 
that will allow her to "sleep nights, '' will be wise 
not to attempt school nursing, at least not in a 
large city where school buildings have many flights 
of stairs, where the child whose condition requires 
a home call invariably lives on the "third floor 
back,'' and where the work is so exact jpg as to 
demand attention in all kinds of weather and under 
many trying circumstances. Good physical health 
usually means good mental health, which is essen- 
tial, as the school nurse is called upon to exercise 
to the fullest her powers of observation, judgment, 
and discretion. 

Habits of exquisite daintiness in personal matters, 
and extreme neatness and order in equipment and 
supplies are important in one who is to instruct 
children in personal hygiene, and personal neatness ; 
and the beauty of simplicity in dress should be 
demonstrated by the nurse who is looked upon as 
an example by girls who are at the age when perma- 
nent tastes are being formed. It is with apologies 
to the vast army of nurses who appreciate the 



20 HANDBOOK FOR SCHOOL NURSES 

eternal fitness of things that mention is made here 
of the use of cosmetics, but vivid recollection of 
wofnen in the uniform of school nurses who were 
painted and powdered in a manner entirely un- 
professional makes it necessary to warn nurses that 
a wrong influence is as far-reaching as a good one, 
and that the school nurse who will resort to rouge 
and extremes of hair dressing to increase her charm 
may be the means of starting some silly school- 
girl on the road to ruin. 

Besides quick perception, keen observation, good 
judgment, initiative, the faculty of quick decision, 
good memory, and a cheerful disposition, the suc- 
cessful school nurse must have faith in her work 
and in its ultimate success, she must be able to 
cooperate with other workers, and be able to present 
facts clearly to others. Add to all these a broad 
charity, a love of children, and the desire to do her 
share of the world's work, and the nurse has an 
ideal equipment for the work in the schools. It 
may be said that this picture of what the school 
nurse should be is more ideal than practical, but 
an intimate acquaintance with any large group of 
public health nurses will prove that this ideal is 
not, after all, so far removed from the real. 

Uniform : There is still a question in the minds 



ORGANIZATION AND ADMINISTRATION 21 

of many nurses as to whether the school nurse should 
wear a uniform, though the weight of opinion among 
nurses who have been consulted on the subject is 
in favor of a uniform, for the following reasons : 

A worker in uniform carries with her all the 
authority of the organization which she represents. 
This is important when working among people of 
foreign birth who usually have a great deal of re- 
spect for constituted authority, of which the uniform 
is the outward and visible sign, and greater respect 
and attention are shown the nurse in uniform than 
would be accorded her were she in civilian dress. 

All classes of people know and respect the nurse's 
uniform. Rough characters who have little regard 
for law or order unconsciously respond to the in- 
fluence of the nurse, for they know that she repre- 
sents unselfish service. The uniform is therefore 
its own reason for going about in all sorts of neigh- 
borhoods. 

J When a uniform is worn, it should consist of a 
plainly made dress of washable material, preferably 
dark blue or gray, with white collar and cuffs, a 
piain, dark, full-length coat, and a plain hat, of 
straw or felt, in some modification of the sailor 
shape. An apron should be carried in the satchel 
to be worn while actually at work. 



22 HANDBOOK FOR SCHOOL NURSES 

Shoes should be comfortable and sendceable, 
and preferably of black leather. Some nurses are 
of the opinion that tan shoes are more comfortable, 
but it is doubtful whether the difference is sufficient 
to warrant the break in the uniformity of the staff. 
White, gray, or other fancy shoes are out of place 
when worn with a school nurse^s uniform. 

The Nurse's Handbag : 

The handbag carried by the nurse should be large 
enough to hold the necessary equipment, but not so large 
as to be a burden. The bag in use by the Chicago nurses 
is of black leather, 14 inches long, 5 inches deep, and 4 
inches wide. It has a flap cover which closes with a 
strap and buckle. Each bag is provided with two remov- 
able linings of white canvas, with pockets to hold dress- 
ings, bottles, jars, and note books. The lining is fastened 
to the inside of the bag with snaps, and is easily removed 
when soiled. 

Supplies for Bag : 

Fountain Pen Absorbent Cotton 

Pencil Gauze 

Small Writing Pad Narrow Bandages 

Note Book Adhesive 

Tr. Green Soap Toothpicks 

Collodion Small Basin 

Tr. Iodine Towel 
White Precipitate Ointment Apron 



ORGANIZATION AND ADMINISTRATION 23 

Instrument case containing : 

Scissors, Tissue Forceps, Thermometer, Tongue De- 
pressors. 

Equipment for Schools : 
Supply bottles containing : 

Alcohol, Tr. Iodine, Tr. Green Soap, Arom. Spts. 
Ammonia, Collodion, Oil of Cloves. 

Supply jars containing : 

Cotton, Gauze, Bandages, White Precipitate Ointment, 
Vaseline. % 

Two Hand Basins, Towels. 

A folding stretcher, which can be used in case of 
accident on the playground, will be found very 
convenient. 

Ethics as Applied to the Work of the School Nurse : 
The accepted ethical code of the nursing profession 
is as applicable, and as essential, in school nursing 
as it is in private duty, or in hospital service ; and 
the nurse who has received careful ethical training 
in her undergraduate days will seldom go far astray 
in solving the problems met in public health work. 

There are, however, a few points which need 
special emphasis, and these are presented here 
more to refresh the memory than to present any 
new ideas on the subject. 



24 HANDBOOK FOR SCHOOL NURSES 

The nurse should be thoroughly informed as to 
the various activities of the organization which 
employs her, and should be able to explain and sup- 
port its policies. When she cannot conscientiously 
do this, the only honorable course open to her is 
to sever her connection with it. The nurse who will 
criticize, or allow others to criticize, the organiza- 
tion with which she is connected, is falling far short 
of the ideals of her profession, and will not be able 
to gain the confidence and trust of the people in 
her district. Unquestioning obedience of all orders 
and rulings of her organization is necessary if the 
best results are to be obtained. Economy of time 
and supplies will do much to further the work, mak- 
ing it possible to care for more people with the same 
expenditure of time and money. 

The ability to work harmoniously with other 
individuals and organizations is of paramount im- 
portance, as most social problems are too compli- 
cated, and involve too many factors, to permit of 
solution by one individual. The nurse must be 
able and willing to work as cheerfully for a case 
which will reflect credit on some one else as for one 
which would redound entirely to her own glory. A 
nurse is sometimes jealous of the right to care for 
the families in her own district; but this spirit, 



ORGANIZATION AND ADMINISTRATION 25 

while displaying interest and devotion, also betrays 
a narrowness which will, sooner or later, interfere 
with her usefulness even in that district. Co- 
operation is, and must be, the keynote of all suc- 
cessful public health work. 

Courtesy and a kindly interest in the people 
with whom she comes in contact will open many 
doors and smooth many rough places in the path 
of the school nurse, particularly if wedded to that 
other golden virtue. Patience. 

Relation to Coworkers : The nurse's attitude 
toward the Health Officer in her schools should be 
that of a wilhng assistant. Where she cannot con- 
scientiously preserve this attitude, her reasons 
should be stated in writing to the Supervising Nurse 
in her district, or to some one in a position to see 
that the matter is looked into, and the standard of 
the service maintained. Toward the supervising 
staff of the nursing service, her attitude is that of 
a well-informed nurse toward an executive ojfficer 
in any line of nursing work. 

With the educational force in the schools, the 
nurse should cooperate to the fullest in the attain- 
ment of their common object : the wellbeing of 
the child; and all other interests must be made 
subservient to this if the highest possibilities of the 



26 HANDBOOK FOR SCHOOL NURSES 

service are to be attained. Social visiting, or any 
other departure from a strictly professional and 
business-like attitude is sure to bring regret to the 
nurse, and should be carefully guarded against. 
The successful nurse preserves a cordial, friendly 
attitude toward the teaching staff, but does not 
allow anything in the nature of familiarity or 
patronage. 

The principal of the school is its recognized head, 
and is responsible for conditions in that school, con- 
sequently he should be kept informed of all the ac- 
tivities being carried on there. When medical 
inspection is conducted by the Department of 
Health, or any agency other than the Board of 
Education, the character of the work and the 
methods of procedure should be clearly explained 
to the principal before any action is taken in that 
school. All contemplated changes in the plan of 
work should be brought to his attention, that he 
may know what is being done in his school. 

When any difference of opinion arises in the 
schools, the nurse should simply state the ruling of 
her organization in regard to the matter under dis- 
cussion ; say that she must abide by the rule, and 
refer the matter to her Supervisor. The nurse 
gains nothing by entering into arguments as to the 



ORGANIZATION AND ADMINISTRATION 27 

practicability of rules which she has no power to 
change. If she thinks a change advisable, she 
should recommend to the Central Office that the 
rules be revised and give her reason. All such 
recommendations should be made in writing. 

Much of her success or failure will depend on her 
ability to fit her work into the daily program of the 
schools without causing disturbance or interruption 
of classes. Teachers should always be consulted 
as to the most convenient time for making routine 
inspections in their rooms, and should be notified 
in advance when cultures, vaccinations, or any other 
unusual procedures are to be carried out. Many of 
the misunderstandings between the nurse and the 
school authorities arise from the failure of the 
nurse to realize that she is not in the school in her 
personal capacity, but as the representative of a 
recognized public health agency; that criticisms of 
her work are not personal matters, but pertain to 
the system under which her activities are carried 
on, and should be referred to a higher authority for 
adjustment. Not until the nurse realizes her official 
position, and is able to eliminate entirely the per- 
sonal equation, will it be possible for her to hold a 
straight course among the many obstacles met in 
the performance of her day's work. 



CHAPTER III 

PLAN AND CHARACTER OF WORK; PREVENTION 
OF CONTAGION; PRELIMINARY INSPECTIONS- 
ROUTINE INSPECTIONS— EMERGENCIES— PHYS- 
ICAL EXAMINATIONS — VACCINATIONS — CUL- 
TURES;] DRESSINGS; TREATMENT OF MINOR 
CONTAGIOUS DISEASES; HOME CALLS; DIS- 
PENSARIES; HOSPITALS; A TYPICAL DAY'S 
WORK 

The hours of duty are usually, from eight-thirty 
or nine o'clock in the morning, until five or five- 
thirty in the evening, with an hour for luncheon. 
The hours from nine in the morning, until five in the 
afternoon, are to be recommended, as longer hours 
tend toward mental and bodily weariness, which 
make for inferior work. Here as elsewhere in nurs- 
ing, occasional departures from the rules governing 
the hours on duty will be foimd necessary, and here 
as elsewhere, those charged with the direction of 
the work, must guard against the possibility of a 
nurse being carried, by her enthusiasm, beyond her 
physical strength. This is particularly important 
in school nursing, as nurses are left very much to 

28 



PLAN AND CHARACTER OF WORK 29 

themselves in their districts. Occasionally the other 
extreme is met with, but to the credit of our profes- 
sion be it said; for every one who tries to shirk 
her responsibilities, a score will be found anxious 
to work until satisfactory results have been ob- 
tained, regardless of the hour. One half day, be- 
sides Sunday, should be taken each week for rest 
and recreation. This is usually arranged for Sat- 
urday afternoon, the morning being spent in follow- 
up work. 

Sometimes a nurse organizing school Vork in a 
new community, finds that her evenings as well as 
her days, are taken up with matters pertaining to 
her work, and that no time is left for her personal 
affairs, or for recreation, with the result that her 
health is impaired, her enthusiasm wanes, and soon 
not only she herself, but the community, becomes 
disaffected with the work; the nurse resigns and 
public health nursing in that community receives 
a serious blow, from which it may require years to 
recover; whereas, if a slower pace had been set at 
the beginning, it could have been increased grad- 
ually, with increased knowledge of local conditions, 
and the work carried on to success. 

School Work : Before deciding on a definite plan 
of work in any school, the nurse should confer with 



30 HANDBOOK FOE SCHOOL NURSES 

the principal, as to where she is to do her work, 
what facilities are to be provided for keeping rec- 
ords, supplies, etc., and what signal shall be used to 
notify the principal and teachers of her arrival. 
When a plan has been decided upon, the nurse 
should be most scrupulous in adhering to it, and 
should not make any change without the knowledge 
of the principal. In most schools the nurse an- 
nounces her presence by ringing a bell, in others a 
note is sent to the teachers, notifying them of the 
arrival of the nurse. Whatever be the plan fol- 
lowed, the nurse upon announcing her presence, 
goes to the room assigned her, and makes the 
necessary preparation for the work to be done. 
When the physician is in the school at the time of 
her visit, she assists him with whatever work he 
may have planned. Children awaiting readmis- 
sion after absence, receive attention before other 
pupils are brought in, and if, in the judgment of the 
physician, they may be readmitted, they are sent 
to their classrooms with the least possible delay. 
If for any reason they cannot be returned to their 
classes, they are sent home, with instructions as to 
when to return. In some cases it will be necessary 
for the nurse to call at the home for the further 
instruction of the mother. 



PLAN AND CHAKACTER OF WORK; 31 

When these children have been disposed of, atten- 
tion is given those pupils referred to the physician 
by the teachers. A monitor is sent to the rooms 
for a limited number of children, usually four or 
five. The nurse takes from the file the physical 
record cards of the children sent for, and gives each 
pupil's card to the physician as the child is presented 
for inspection. While this group is being inspected, 
another group is sent for, each child returning to 
his classroom immediately after the physician has 
inspected him, thus preventing delay and confu- 
sion. Children foimd to be suffering from minor 
contagious skin diseases, and from pediculosis, are 
diagnosed by the physician, and referred to the nurse 
for treatment. When pediculosis is found, the child 
is given a sealed envelope containing printed instruc- 
tions as to the treatment to be carried out, and 
instructed to give it to his mother. 

When live pediculi are present, the child should 
be excluded (it is often necessary for the nurse to 
visit the home to see that the prescribed treatment 
is carried out). Contagious skin diseases, unless 
grave, may be treated by the nurse at school, thus 
preventing loss of time. Severe cases should be 
referred to the family physician or to a dispensary, 
for treatment. When a child shows evidence of 



32 handbook; for school nurses 

a physical defect, a card is sent to the parents ask- 
ing permission to make a physical examination and 
requesting the mother to be present when the exam- 
ination is made. 

When all referred cases have been cared for, 
unless some special work, such as cultures, vaccina- 
tions, or physical examinations, is to be done, the 
nurse proceeds to the next school on her schedule 
where the same program is carried out. When she 
has completed her work with the school physician, 
she is ready to make routine inspections, file record 
cards, or do any other work remaining to be done in 
the schools, or she may make home calls, or take 
children to a dispensary. 

When there is no physician in the schools, the 
nurse may follow some such plan as the above, refer- 
ring cases of suspect contagious disease, and of phys- 
ical defects, to the family physician, or to some other 
physician with whom arrangements have been made 
for free care for the children of indigent parents. 

The function of the school nurse is threefold. 
She assists in the prevention of contagion and in 
the correction of physical defects, and is responsible 
for the education of children, and sometimes of 
their parents, in the principles of personal and 
public hygiene. 



PLAN AND CHARACTER OF WORK 33 

Prevention of Contagion: The prevalence of 
contagious diseases among school children was the 
principal factor involved in the conditions which 
resulted in calling the school nurse into existence; 
and the prevention of these diseases is still her main 
reason for being. 

Through careful inspection of all children in the 
schools at regular intervals, evidences of contagion 
are discovered, and the child under suspicion is 
excluded before the other children have been ex- 
posed to infection. By prompt reports to the 
Department of Health of all suspected contagious 
cases, quarantine can be instituted at the home, 
and the dangers of contagion from that quarter 
greatly reduced. This reporting of suspected con- 
tagious diseases by the school nurse is one of the 
most important factors in the prevention of con- 
tagion in schools. 

For the contagious skin diseases, treatment should 
be given by a private physician, at a dispensary, 
or in minor conditions by the nurse at school, under 
the direction of the school health officer. The 
reduction in the number of exclusions for the minor 
contagious diseases is one of the most noticeable 
results of the nurses' work in the schools. This is 
also one of the best tests of a nurse's efficiency. 



34 



HANDBOOK FOR SCHOOL NURSES 



The following tables of minor contagious skin 
diseases found, the first taken from the records of 
a public school, the second from a parochial school, 
in an average district in Chicago, will give an idea 
of what the nurse has accomplished in the matter 
of these diseases. In many districts the contrast 
is much more marked. 





Nc 


. 1 


No 


. 2 




1913 


1917 


1913 


1917 


Pediculosis 


300 


18 


351 


49 


Ringworm 


45 


2 


26 


2 


Impetigo 


598 


51 


601 


74 


Favus 


8 





3 





Scabies 


20 





18 






Preliminary Inspections: In making prehminary 
inspections after each vacation period of one week 
or more, the nurse visits each classroom, stands 
with her back towards a window, and has all the 
children in that room file past her, each holding 
out his hands with palms and wrists exposed. He 
then opens his mouth, puts out his tongue, and 
with the fingers of one hand pulls down the eyelid 
in such a way as to expose the conjxmctiva. In- 
structions should be given the class before the in- 
spection is begun, so each pupil will know what is 
expected of him. 



PLAN AND CHARACTER OF WORK 35 

In this hurried inspection it is possible to detect 
only the most obvious evidences of contagion, such 
as desquamation, coryza, conjunctivitis, and in- 
flamed tonsils. The nurse does not touch the child 
during this inspection. 

Daily Inspections : All children who have been 
absent from school for two or more days should be 
examined by the Health Officer, or in his absence, 
by the nurse, before being admitted to the class- 
room. These children should, on theiii return to 
school, be sent by the principal to a room reserved 
for this purpose where they will not come in contact 
with other children and where they can be examined 
before being returned to their classes. 

Routine Inspections: Nurses should make rou- 
tine inspections of all children in their schools once 
in two months, or oftener if possible. In making 
these inspections the nurse takes each child by 
himself in the cloak room adjoining the classroom, 
if it is provided with a window; in a screened off 
end of the hall; or failing better quarters, at the 
back of the classroom; where the work can be 
done without disturbing the work or attracting the 
attention of the class to the child who is being 
examined. A good light is essential, the nurse 
standing with her back toward it. 



36 HANDBOOK FOR SCHOOL NURSES 

The eyelids, throat, skin, and hair of each pupil 
are examined, and the general condition as regards 
cleanliness, nutrition, etc., noted. In making this 
inspection the nurse need not touch the child, who 
should be instructed to open the mouth, pull down 
the eyelids, and show hands and wrists. In examin- 
ing the hair the nurse should use two toothpicks, or, 
if she is economically inclined, one toothpick broken 
in two, lifting and separating the hair so as to expose 
the scalp. 

Emergency Treatment : Emergency treatment for 
cuts, burns, skin wounds, etc., may be given by the 
nurse. The parents are then advised to continue 
treatment, or have the child placed under a physi- 
cian's care. 

Physical Examinations : In schools where physical 
examinations of school children are made as a rou- 
tine procedure, the nurse assists by giving out the 
consent cards for the parent's signature ; also the 
blanks for the family history. At the time of the 
examination she can assist by filling in the various 
items on the physical record card ; by having the chil- 
dren brought to the health officer in proper order ; by 
taking the height and weight ; by preserving disci- 
pline among the children; and by filing the record 
cards when the examinations have been completed. 



PLAN AND CHARACTER OF WORK; 37 

Physical findings are usually recorded on a white 
card; while contagious diseases, exclusions, referred 
cases, etc., each has a distinctive colored card. 

The principal defects met with are decayed teeth, 
defective vision, enlarged tonsils, and adenoids. 
For these and other remediable conditions noted, a 
physical defect notice is sent to the parent, calling 
attention to the defect and advising that the child 
be taken to a private physician, a dentist, or a 
dispensary, as the case may be. If th^ child is 
not placed under treatment within a reasonable 
time, the nurse visits the home to learn the financial 
condition of the family and the reasons for failure 
to secure treatment for the child. Ifc often re- 
quires repeated visits and much moral suasion to 
induce the parents to have their children given 
medical care ; and occasionally it may be necessary 
to invoke the aid of the courts, which is not a very 
satisfactory proceeding, as few states have laws 
compelling indifferent or ignorant parents to give 
their children the medical care that will prepare 
them for good citizenship. 

If a mother is unable to take a child for treat- 
ment because she is the wage earner or because 
she has at home smaller children who cannot be 
left alone, the nurse, with the written consent of the 



38 HANDBOOK FOR SCHOOL NURSES 

parents, accompanies the child to insure treatment 
being given. 

Vaccinations : When vaccinations are done in 
school, the nurse assists by securing the written 
consent of the parent, arranging with the principal 
for having the children sent to the medical inspec- 
tion room at the right time and in proper order, 
by preparing the children's arms, and applying 
shields after vaccination. 

Cultures : When cultures are being made from 
the throats of all pupils in a room, the nurse assists 
with the clerical work, labeling tubes, etc. 

It is often necessary, in the absence of a physician, 
for the nurse to make a culture from a suspicious 
throat, and every school nurse should be familiar 
with the proper technic for this purpose. If she 
has any doubt as to her ability to take a nose or 
throat culture correctly, she should ask some phy- 
sician to give her the necessary instruction. 

Dressings : In the Chicago schools no dressings 
are done, except for emergencies and minor skin 
diseases; the treatment for the latter being pre- 
scribed by the Department of Health. In some 
places, treatment of wounds, infections, etc., is 
continued until healing has taken place. In still 
other commimities, school clinics are conducted, 



PLAN AND CHARACTER OF WORK 39 

where all the ailments of the pupils are diagnosed, 
and treatment prescribed, and in some cases, carried 
out. The amount of curative and corrective work 
done in the schools will depend largely on the local 
facilities for dispensary treatment, and upon the 
attitude of the local physicians. There is no doubt 
that a considerable amount of dressing should be 
done in the schools, if it is to be done at all, as many 
parents are so ignorant, or indifferent to the welfare 
of the children that they pay no attention to minor 
injuries or infections. There is really^very little 
ground for opposition to school treatments on the 
part of the medical profession, as at least ninety 
per cent of such cases would never be taken to a 
physician. 

Treatment of Minor Contagious Skin Diseases^ 

Impetigo : Remove crusts, wash lesions with 
green soap and water, and apply white precipitate 
ointment. 

Ringworm: Scrub each patch thoroughly with 
green soap and water, wipe diy, and apply Tr. 
Iodine, cover lightly with cotton and flexible 
collodion. Dress daily, being careful to remove 
the old dressing very gently. 

^Prescribed for use in the schools of Chicago and Milwaukee. 



40 HANDBOOK FOR SCHOOL NURSES 

Favus (Ringworm of Scalp) : Cut the hair as 
close as possible, scrub patches with green soap and 
water, apply Tr. Iodine, and cover lightly with 
cotton and collodion. 

Scabies : Have patient's body rubbed thoroughly 
with green soap and water, after which give a hot 
bath. Apply a ten per cent sulphur ointment over 
the entire body. Have patient wear the same 
underclothes for three days and nights when a hot 
bath is given, and the imderclothes and bed linen 
are sterilized by boiling. The treatment is then 
withheld for a period of three days to allow irritation 
to subside. If itching recurs, ointment is again 
applied and the process repeated. 

Pediculosis : Mix equal parts of kerosene and 
olive oil and rub the mixture well into the hair and 
scalp. Fasten the hair on top of the head and cover 
with a towel or a piece of muslin to form a cap. 
Do not bring the head in contact with a gas jet or 
flame of any kind. After six or eight hours wash 
the hair well with soap and hot water, rinse well, 
and dry thoroughly. Wet the hair with hot vinegar 
to loosen the ^ggs or "nits," and comb with a fine 
toothed comb wet with the hot vinegar. Use the hot 
vinegar daily until the "nits" have all been removed. 
Wash the hair once a week to prevent reinfection. 



PLAN AND CHARACTER OF WORK; 41 

The instructions for freeing the hair of vermin 
are printed on slips 3X5 inches in size, which are 
made up into pads of one hundred each. The nurse 
sends one of these slips to the mother of each in- 
fected child with the request that steps be taken 
at once to have the condition cleared up. If nothing 
is done within two or three days, the nurse visits 
the home and urges the mother to begin treatment 
at once, demonstrating the necessary procedures if 
she thinks best. 

Home Calls ^ 

Before calling at a home for the first time, the 
nurse should arm herself with all the available facts 
in regard to the family and the child in whose interest 
the visit is made. School principals know the home 
conditions of most of their pupils, especially of 
those who would be likely to need the assistance 
of the nurse, and are always willing to give this 
information for her use. She must know the correct 
name and address of the child, and exactly the nature 
of the defect for which she advises correction. It 
would make a very unfavorable impression on the 
mother to have the nurse urge treatment for Johnnie's 
teeth when the defect from which he is suffering is 
one of vision. The nurse would probably lose her 



42\ HANDBOOK FOR SCHOOL NURSES 

opportunity, and Johnnie continue to suffer from 
headache and eyestrain. 

It might be wise, if time permits, to make the 
first visit a friendly call, returning after a few days 
to get the required information, and to explain the 
nature of the physical defects. The nurse should 
use the simplest terms possible in explaining to the 
mother the nature of a child's ailments or defects. 
Proper emphasis can be laid on the importance of 
correcting defects without causing needless alarm 
to the mother. 

Parents will usually consent to having the children 
given medical care when they clearly miderstand 
what is needed, and realize that the interest of the 
nurse is centered in the welfare of the children. 

Like every other educational health movement, 
there are times when the work seems discouraging. 
One visit does not always bring results. It some- 
times requires months of weary pleading before 
parents realize the necessity or importance of treat- 
ment, and it is here that the tact and personality 
of the nurse play so large a part. The nurse must 
be a good judge of human nature to know just 
what arguments to bring forth. For instance, to 
know when to point out to the parent that the 
improvement in the physical health of the child 



PLAN AND CHARACTER OF WORK 43 

will make for greater ability to earn his living 
later. 

The nurse who visits a home to advise medical 
care for a child is falling short of her highest possi- 
bilities if she confines her attention entirely to that 
child. There is usually a baby in the home, and 
every mother is made happy by a little attention 
shown to this, the most important member of the 
family ; thus without seeming inquisitive, the nurse 
can learn about the baby's health, its food, whether 
it sleeps well, how it is dressed ; and if tnese condi- 
tions are not favorable to the child's development, 
the mother may be told of the Infant Welfare 
Station in the neighborhood. The nurse might 
even suggest that the Infant Welfare nurse be 
invited to call and see the baby. 

It is also possible in these visits to advise the 
mother as to the children's diet, the importance of 
nourishing food and the dangers of beer, coffee, and 
tea, the need of fresh air in sleeping rooms, the 
importance of cleanliness both of person and cloth- 
ing, and the treatment of pediculosis and other 
minor skin diseases. 

Foreign-born mothers often object to their daugh- 
ters wearing glasses, fearing that it may interfere 
with their matrimonial prospects. These mothers 



44 HANDBOOK FOR SCHOOL NURSES 

should be told that wearing glasses during school 
life may obviate the necessity for wearing them 
later on. 

The nurse must be able to judge with a fair degree 
of accuracy, whether or not the parents can afford 
to pay for treatment, or whether the child must be 
taken to a dispensary. Information as to income, 
expense, number in family, occupation, race, and 
religion can be obtained without giving the mother 
the impression that she is being investigated, if 
the nurse will use a little diplomacy and good 
judgment. Where time is not an important factor, 
it is better to make a second call before deciding 
definitely that the child should receive free treat- 
ment. 

Extreme care should be exercised in the matter 
of free treatment, as all the physical benefits de- 
rived therefrom may be nullified by the moral 
injury done through accepting something for which 
no payment is made. The burden of responsibility 
for the welfare of the child belongs on the shoulders 
of the parents, and should not be lightly removed. 
They should be urged to have the physical defects 
of their children corrected, even at the cost of some 
sacrifice. When they cannot afford to pay for the 
services of a private physician, they should be 



PLAN AND CHARACTER OF WORK; 45 

urged to take the child to a dispensary for free 
treatment. It may sometimes be necessary for the 
nurse to accompany the mother on the first trip 
to the dispensary, but this should be done with 
discretion. Even in cases where it is impossible 
for the parents to pay full price for treatments, 
spectacles, etc., they should be allowed to keep 
their self-respect by paying what they can afford. 
When hospital care is necessary, it often devolves 
upon the nurse to make all the arrangements for 
admission to the hospital. In all cases parents are 
urged to accompany the nurse, so that they may 
become familiar with the location of the different 
relief agencies, and the hours of service for the 
particular ailment of the child. It is much more 
difficult to obtain results in the poorer districts 
because of the inability of the parents to understand 
that the interest of the nurse in the child is purely 
humanitarian, and it is almost always necessary 
for the nurse to accompany foreign-born children 
and their parents to the dispensary and hospital. 
These visits are made after school hours and on 
Saturdays. It often seems that an enormous amount 
of time is wasted waiting at the dispensary and at 
the doctor's office, but when the case has been 
closed satisfactorily and no harm has befallen the 



46 HANDBOOK FOR SCHOOL NURSES 

child in the many journeys to and fro, the nurse 
realizes that after all the time has been well spent. 

Arguments to be Used in Urging the Correc- 
tion OF Physical Defects 

Defective vision may cause headaches, inflamed 
eyelids, and squint. Children with poor sight are 
often retarded in their classes, because using the 
eyes causes pain, fatigue, and nervousness. Neg- 
lected visual defects may result in blindness and 
consequent dependency. 

Decayed teeth cause an unclean mouth, bad 
breath, toothache, and diseases of the gums. In- 
digestion and general ill health may be caused by 
inability to chew food properly because of defective 
teeth. Disease germs lodge and multiply in the 
cavities of decayed teeth, rendering the child more 
susceptible to contagious diseases. 

Adenoids interfere with breathing through the 
nose, causing mouth breathing and deformities of 
the nose and palate. Adenoids may also be a source 
of infection of the cervical glands, and when large, 
may cause deafness by closing the eustachian tube. 

Enlarged tonsils increase susceptibility to ton- 
sillitis, cervical adenitis, rheumatism, diphtheria, 
and other contagious diseases. 



PLAN AND CHARACTER OF WORK; 47 

Physical defects should be cared for while the 
child is young, so that his school work will not be 
interrupted, that he may be relieved from suffering, 
be able to keep up with his class work, and leave 
school prepared to earn his living and take his 
place as a useful citizen. 

An idea of the detail involved in school nursing 
may be gathered from the report of one day, Mil- 
waukee schools. 

8 : 30 A.M., arrived at first school. Room : Prin- 
cipaFs Oj0&ce. Instructed twenty-five children per- 
sonally as to the removal of vermin. Arranged 
to take one eye case to dispensary. Dressed a cut 
hand. Found three cases on absence Kst that re- 
quired looking up. Dressed two cases of infected 
fingers. Saw four cases of impetigo and gave 
necessary instructions for care of same. Made out 
report for that school on daily report card and left 
for the next school. Met a Child Welfare nurse 
on the way who reported a family that needed 
aid. One boy could not attend school because he 
had no shoes. Promised to see child and get shoes, 
which was done through the Woman's School 
Alliance. 

Second School : Gave four appointment cards for 
Free Dental Clinic. Saw four new cases of impetigo 



48 HANDBOOK FOR SCHOOL NURSES 

and scabies ; parents indigent, so children are cared 
for in school. Four cases of pediculosis carefully 
examined at request of teacher and found to be 
infected with live pedicuH. Excluded children and 
notified principal. (Later call was made on mother 
who was advised, and shown how, to treat. Printed 
instructions left for future treatment.) Found note 
from another teacher stating that nine-year-old boy 
was absent because of illness. Call made later. 
Found boy with temperature of 101, pulse 120. 
Pain, redness, and swelling in leg, which he had 
bruised at play two days previously. Mother a 
widow receiving widow's pension. County physician 
notified. (He arrived same afternoon and diag- 
nosed case as osteomyeHtis. Boy later removed to 
County Hospital for treatment.) Three tonsil and 
adenoid cases advised, two cut and bruised hands 
dressed. On the way to the next school made 
home calls. 

Third School : Found principal in his office. 
Inquired if he had any special cases. Then sorted 
out cards of children to be seen. There were about 
twenty which were given to messenger for distribu- 
tion. Cleaned out medicine cabinet and supply 
drawer. Saw children who brought their cards. 
Two eye cases, one impetigo, three pediculosis, and 



PLAN AND CHARACTER OF WORKi 49 

fourteen miscellaneous. Changed two dressings. 
Made a list of eases absent because of illness. 

12 M., left for lunch. 

Fourth School : On the way met a woman who 
asked what to do for a burn. The baby had been 
burned two weeks previously. All healed except 
one place which had pus in it. Treatment explained. 
At the home found two children with "hard colds.'^ 
Elder one had temperature of 102 and pains in 
chest, back, and abdomen. Advised family physi- 
cian, whom mother promised to c^l. Gave in- 
structions on care of child, and the need of fresh 
air in the home. House heated by two gas heaters. 
Seven members of family living in three rooms. 

Arrived at School : Asked teacher about children 
absent because of illness. Found several children 
in school with toothache. Gave temporary rehef 
and arranged with principal for them to go to dental 
clinic after school for first aid treatment. Saw one 
boy of fourteen in Special Class doing third grade 
work. Vision very defective and glasses broken. 
Family indigent and School Board had paid for 
glasses. Reminded him of his appointment at the 
dispensary for refraction. A finger was bandaged, 
and ointment appHed to several little faces having 
impetigo or scabies. Two new cases had been re- 



50 handbook; for school nurses 

ferred as candidates for the Fresh Air Class. Visited 
afternoon kindergarten and advised teacher of re- 
sult of home calls. Left school to make home calls. 
The mother of two under-nourished children ad- 
vised, and Fresh Air Class explained to her. One 
absentee found to have chicken pox. Case re- 
ferred to Health Department. Made several more 
home calls, returned home for supper and lecture 
in evening. 

This is just a glimpse of the many-sidedness of 
school nursing. 



CHAPTER IV 

EDUCATIONAL WORK: ROUTINE TALKS — HEALTH 
LEAGUES — BOYS' CLUBS — PARENT-TEACHER 
ASSOCIATIONS 

Routine Talks : Either before or after the rou- 
tine inspection in the classroom, a short talk should 
be given the class on some phase of pers(^al hygiene 
and its application to the life of the child. These 
talks should be given according to a definite plan, 
to prevent repetition in one room, with possible 
omissions in another. 

The following list of topics will serve to suggest 
to the nurse some plan for her routine talks : 

1. The importance of health. 

2. The relation of good physical health to progress in 
school. 

3. The cornerstones of health — Cleanliness, fresh 
air, exercise, food. 

4. Bathing. 

5. Care of teeth. 

6. Care of hair. 

7. Care of hands. 

8. Clothing. 

9. Food — Water. 

51 



52 HANDBOOK FOR SCHOOL NURSES 

10. Ventilation. 

11. Exercise. 

12. Rest — Sleep. 

Other topics for these talks will be brought out 
during routine inspection and oftentimes a text 
suggested by the day's work will be more interest- 
ing than the one scheduled for that da}^, the im- 
portant thing being to give the talk at this time 
while the minds of the children are fixed on health 
matters. 

Many opportunities present themselves for health 
instruction of individual pupils, and these oppor- 
tunities should not be neglected, as a word spoken 
at the right moment may have a lasting influence 
on the child's life. 

School nurses are frequently asked to advise girls 
on matters of personal and social hygiene, and should 
be prepared to give the necessary biological infor- 
mation in a straightforward, wholesome manner. 
This information should be given individually and 
only with the consent of the girl's mother, who is 
the natural instructor of the girl in such intimate 
matters. When a girl asks the nurse for this in- 
formation, an appointment should be made for a 
conference at some later date. In the meantime, 
the nurse should visit the mother, tell her that the 



EDUCATIONAL WORK; 53 

girl has asked for this information, and learn whether 
the mother wishes to assume her obligations in the 
matter, or to have the nurse discharge them for her. 
Though many cases will be found in which the 
mother, for one reason or another, cannot be in- 
trusted with this task, there will be many others 
in which she should be urged to undertake it, and 
thus keep the confidence of her daughter. 

Much educational work is done by the nurse on 
her visits to the homes. When once she has gained 
the confidence of the mothers in her district, she is 
consulted on all subjects — ^ social, moral, financial, 
and culinary — and if she is clever enough to see and 
improve her opportunity, she can usually inject a 
little hygiene and civic responsibility into her 
advice. 

Girls' Health Leagues 

These leagues, known as Little Mothers' Clubs, 
were organized in the Chicago schools as an aid in 
the campaign for Infant Welfare. It was soon 
found that it would be impossible, as well as inad- 
visable, to confine the instruction to the care of the 
baby, as many other health questions were con- 
tinually coming up, and demanding attention. 
The outline for the course was, therefore, revised 



54 HANDBOOK FOR SCHOOL NURSES 

to include many topics concerned with home and 
neighborhood sanitation, function of the Health 
Department, and method of reporting unsanitary 
conditions, prevention of contagion, the responsi- 
bility of the individual citizen to the health of the 
community, elementary first aid, etc. 

The name Health League is preferable to 
Little Mothers' Club, as the latter suggests, to 
some people, the idea of sex hygiene, and many 
mothers objected to their daughters taking up the 
work because they feared that this subject would 
be taught. It required much patience and diplo- 
macy on the part of the nurse to overcome this 
idea. That it has been overcome is evidenced by 
the fact that among the most enthusiastic supporters 
of the Health Leagues are the teachers in many 
parochial schools who are strenuously opposed to 
the teaching of sex hygiene in school. 

The Leagues are organized usually in October, 
and one meeting is held each week, either during, 
or immediately following the afternoon session. 
Some principals allow credit for the work, others 
correlate the work of the League with English, 
physiology, civics, etc. It goes without saying 
that the most successful Leagues are those in the 
schools where the principals are interested. 



EDUCATIONAL WORK 55 

In some of the schools the Leagues are formally 
organized, with president, secretary, and other 
necessary officers elected by the girls; and the 
meetings conducted according to parliamentary 
usage. This gives an insight into the formalities 
of club procedures, which is useful in after life. 

A certificate and pin are given to each girl on the 
completion of the course. Usually a public demon- 
stration of work is given, parents and friends being 
invited to see how much the girls have profited by 
the course, and it not infrequently hapj)ens that a 
mother will confide to the nurse that she has been 
helped greatly by the information brought home by 
her daughter. 

Naturally, to make this work a success, the nurse 
must herself possess the necessary knowledge of the 
subjects taught, and must be able to give that 
knowledge to the children in a way that will hold their 
interest. 

Following is an outline of the work as carried 
on in the Chicago schools. 

First Meeting 

Enrollment: Preliminary talk on the lessons to be 
given, stating objects of the course, i.e. better health con- 
ditions for the city and the individual. 



56 HANDBOOK FOR SCHOOL NURSES 

Second Meeting 
Home Sanitation: 
(A) Cleanliness: 

House : Superfluities, Dust, 

Vermin, Waste. 
Yard : Privies, Garbage, 

Ashes. 
Alley : Manure, Water, 
Refuse. 



(a) Environmental 



(6) Personal { ^^^^ng. 

(c) Filth-borne Diseases : Typhoid, etc. 
{B) Ventilation : 

(a) Amount of Air Necessary for Each Individual. 
Why It Is Necessary. 

(6) Best Method of Ventilating without Causing 
Drafts. 

(c) Importance of Fresh Air in Sleeping Rooms. 
(C) Disease Carriers : 

(a) Flies, Mosquitoes, Roaches, Bedbugs. 

(6) Rats, Mice, Cats, Dogs. 

(c) Old Clothing, etc. 

Third Meeting 
Care of the Baby : 
(A) Baby's Bed : 

(a) Kind of Bed : 

(1) Crib. 

(2) Basket. 

(6) Position of Bed in Relation to : 

(1) Warmth. 

(2) Ventilation. 

(3) Light. 



EDUCATIONAL WORK 57 

Fourth Meeting 

(c) Bedding : 

(1) Mattress : Hair, Cotton, Excelsior, Tick. 

(2) Pillows : Hair, Cotton, Down, Feathers. 

(3) Blankets : Wool, Cotton. 

(4) Sheets, etc. : Cotton, Linen. 

(5) Cleaning Bed : Dust, Vermin. 

(6) Making Bed. 

(7) Cost of Materials. 

(d) Position of Baby in Bed, Necessity for Chang- 

ing Position. 

Fifth Meeting ^ 

(B) Clothing: 

(a) Materials : Comparative Value of : 

(1) Cotton, Wool, Silk, Linen. 

(2) Cost of Each. 

(6) Patterns: Styles of Clothing : 

(1) Simplicity. 

(2) Perfect Freedom Necessary. 

(3) Cost of Outfit. 

(4) Care and Washing of Clothing. 

Sixth Meeting 

(C) Bathing: 

(a) Preparation of Bath : 

(1) Necessity for Having Everything Ready. 

(2) Articles Necessary. 

(3) How to Handle Baby : Reasons. 

(6) Washing: 

Tub Bath. 

(1) Face, Head, Nose, Ears, Body Sponge 

Bath. 



58 HANDBOOK FOR SCHOOL NURSES 

(2) Position of Baby during Bath. Support to 

Head and Back in Tub. 

(3) Drying Baby's Body — Warm Towels. 

Seventh Meeting 

(c) Dressing the Baby : 

(1) Shirt, Diaper, etc. 

(2) How to Put on Skirt and Dress. 

(3) How to Fasten Baby's Clothing. 

Eighth Meeting 
(D) Feeding: 
(a) Natural : 

(1) Advantages. 

(2) Importance of Regular Feeding. 

(3) Dangers of Over-feeding. 

(4) Dangers of Handling Immediately after 

Nursing. 
(6) Artificial : 

Source of Supply. 
Care in HandUng. 
Keeping Milk, Improvised 
Ice Box. 

(2) Commercial Foods : Barley Water, Rice 
Water. 

(3) Importance of Pure Water to Drink. 

Ninth Meeting 

Modification of Milk : 
(a) Pasteurization: 

(1) Reasons for. 

(2) Methods Employed. 



(1) Cow's Milk 



EDUCATIONAL WORK 59 

(6) Sterilization : 

(1) Where Employed. 

(2) Methods. 

(c) Rice Water, Barley Water, Boiled Water. 

Tenth Meeting 

Summer Care of Babies : 

(A) Causes of High Death Rate in Summer : 

(1) Artificial Feeding. 

(2) Impure Milk. 

(3) Indigestible Foods. 

(4) Over-Feeding. * 

(5) Irregular Feeding. 

(6) Unsanitary Condition of Home : 
(a) Filth. 

(6) Flies, 
(c) Bad Air. 
id) Bad Water. 

(7) Improper Clothing : 
(a) Too Much. 

(6) Too Little. 

(c) Uncleanliness of Clothing. 

(B) Prevention of High Smnmer Death Rate : 
{a) Home Care : 

(1) Cleanliness. 

(2) Proper Clothing. 

(3) Fresh Air. 

, f Quality. 

(4) Proper Food [ ^^^^^^^^ 

I (5) Sufficient Sleep. 



60 handbook; for school nurses 

(6) Educational: 

(1) Health Department 



Doctors. 

Nurses. 

Bulletins. 



(2) League Girl 



Home. 

Neighborhood. 
(3) Press : Instruction in Health Matters. 



Eleventh Meeting 

(A) Signs of Illness : 

(a) Vomiting. 

(6) Rash. 

(c) Restlessness. 

(d) Continued Sharp Crying. 

(e) High Temperature. 
(/) Diarrhoea. 

(B) Normal Development of Baby : 

(a) Weight. 

(b) Length. 

(c) Teeth. 

/7N Tv/r 1 * .• •. [Creeping. 
(a) Muscular Activity i „, „ . 
^ -^ [Walking. 

(e) Speech. 

Twelfth Meeting 

Bandages : 

(1) Triangular, 34-38 in. square, cut diagonally. ' 
Arm Sling. 
Foot. 
Hand. 
Head. 



(a) Unfolded 



EDUCATIONAL WORK 61 



(6) Folded 



'Eye. 

Jaw. 

Neck. 

Palm of Hand. 
(2) Roller: J-8 in. 
(a) Straight. 
(6) Spiral, 
(c) Reversed. 

Thirteenth Meeting 
Making and Carrying Stretcher : 

(1) Coats, Sweaters. 

(2) Blanket. 

(3) Door, Shutter, Boards, etc. 

Fourteenth Meeting 
Injuries and Emergencies : 

(1) Fractures : 
(a) Simple. 

(6) Compound. 

(2) Wounds: 
(a) Incised. 
(6) Torn. 

(c) Punctured. 

(3) Bruises. 

(4) Sprains. 

(5) Burns. 

(6) Convulsions. 

Fifteenth Meeting 
Injuries and Emergencies, continued, 
(1) Foreign Bodies : 
(a) Nose. 



62 HANDBOOK FOR SCHOOL NURSES 

(h) Eye. 
(c) Ear. 

(2) Bites: 
(a) Dog. 
(6) Snake, 
(c) Insects. 

(3) Hemorrhage: 
(a) Nose. 

(6) Wounds. 

(4) Choking. 

(5) Clothing on Fire. 

(6) Frost Bites. 

Sixteenth Meeting 

Resuscitation : 

(1) Fainting. 

(2) Sunstroke. 

(3) Heatstroke. 

(4) Drowning. 

(5) Gas Poisoning. 

(6) Common Poisons. 



Review 

Examination. 

Rehearsal. 



Seventeenth Meeting 
Eighteenth Meeting 
Nineteenth Meeting 



Twentieth Meeting 
Demonstration of Methods. 



educational work 63 

Boys' Clubs 

School nurses are frequently asked to organize 
ind direct clubs for boys, in schools where Girls' 
Health Leagues have been successfully conducted. 
Whether or not this should be done, will depend 
largely upon the personality of the nurse, and her 
ability to get the boys' point of view. As the nor- 
mal boy is an ardent hero-worshiper, it would 
be much the best plan to have these Clubs under the 
direction of a man who, besides being a worthy 
recipient of the boys' admiration, would be young 
enough to enter wholeheartedly into their sports 
and other interests. In such instances the nurse 
could cooperate to the extent of giving talks on 
health, personal hygiene, etc., and, being in the 
schools every day, could act in an advisory capacity 
on all health matters, public and private. 

In one city a school nurse's friendly interest in 
the newsboys in her district, and her thorough under- 
standing of "boy psychology" resulted, with the 
cooperation of the district truancy officer, in the 
passage of a city ordinance regulating the hours 
during which a boy might sell papers on the streets. 

These newsboys were truants, in most cases, be- 
cause of too early and too late hours, and not be- 
cause of any intention of wrongdoing. 



64 handbook; for school nurses 

The nurse, with the approval and support of the 
principal of one of the schools, met the boys after 
school one day each week and talked to them on 
good manners, courtesy, citizenship, the ethics of 
street trades, etc. She was many times called upon 
to act as mediator between the boys and an irate 
property owner, whose windows had suffered in 
the course of an exciting game of baseball. She 
guaranteed the payment of damages, and acted as 
banker until the money was collected, which usually 
required some time, as the payments were made 
in nickels and pennies; but the debt was always 
paid ; for according to the code of the boys, to fail 
to meet a financial obligation would be unbecoming 
a "street merchant/' 

The nurse acquired an intimate knowledge of the 
home surroundings of these young "street mer- 
chants," also a thorough understanding of their 
hopes and aspirations, and it was with a real heart- 
ache that she found the work growing too large for 
her and saw the organization of the Newsboys 
Republic and the appointment of a Supervisor of 
Street Trades under the extension department of 
the public schools. 

These newsboys are now known as the K.C.B.'s 
or Knights of the Canvas Bag. Their laws are: 



EDUCATIONAL WORK; 65 

1. A Knight gives and takes a square deal. 

2. A Knight works hard. 

3. A Knight is cheerful and courteous to everybody. 

4. A Knight is loyal. 

Their motto is 

Clean habits, clean sports, clean speech, clean business. 

What was possible for one nurse in one city is 
possible for other nurses elsewhere, providing they 
have the spirit of helpfulness and can get the boys' 
viewpoint. 

Parent-Teacher Associations 
School nurses are often invited to talk to the 
parent-teacher associations in their schools, and the 
wise one always takes advantage of this opportunity 
to interest the parents in her work, and to secure 
their cooperation. An intelligent explanation of 
the work and aims of her organization will in most 
cases win the interest and support of the parents, 
and will simplify the work of the nurse. These 
meetings might also be utilized for the discussion 
of problems pertaining to the health of the children, 
such as diet, clothing, sleep, play, etc. Mothers 
will ask many questions of a nurse that they would 
hesitate to ask of a physician. 
Other opportunities for educational work are 



66 HANDBOOK FOR SCHOOL NURSES 

constantly presenting themselves in the shape of 
invitations to address Women^s Clubs, Sunday- 
School Classes, Civic Organizations, Camp Fire 
Girls, and many other groups, until her opportunity 
is limited only by her own physical capacity. 



CHAPTER V 

SPECIAL FEATURES : DENTAL DISPENSARIES — 
TOOTHBRUSH DRILLS — FRESH AIR SCHOOLS — 
DIET LISTS — COOPERATING AGENCIES — THE 
SCHOOL NURSE AS AN ATTENDANCE OFFICER 

Free dental dispensaries are maintained in 
many cities and towns as an aid to medical inspec- 
tion. Such a dispensary may be established in a 
school building, or at the Central Office ; and under 
the direction of a dental surgeon who is interested 
in children, can be made an educational as well as 
a corrective center.] 

The same careTshould be exercised in selecting 
children for treatment at the school dispensaries 
as is used where other free treatment is given 
and only those who would not receive care else- 
where should be treated by the school dentist. 
Exception should be made for children suffering 
from toothache, and for other emergencies. 

In communities where there are no dental col- 
leges, or free dental dispensaries, an effort should 
be made to secure the estabhshment of such dispen- 

67 



68 HANDBOOK FOE SCHOOL NURSES 

saries in the schools. This can be done by enlisting 
the interest of the local dentists, who will usually 
be found willing to donate their services for a few 
hours weekly ; while the funds for equipment, etc., 
could be raised by women's clubs or some other 
organization. 

Chicago owes its system of school dental dispen- 
saries to the public spirit of the Chicago Dental 
Society, whose members donated their services for 
the examination of children in the schools ; secured 
equipment for ten dispensaries; and pleaded the 
cause of the children so ably, that one of the city's 
philanthropists paid the salaries of ten dental sur- 
geons for two years, when sufficient proof had been 
collected to demonstrate to the City Council the 
importance of continuing the work ; with the result 
that it was taken over by the Department of Health 
as part of the medical inspection of schools. 

The following extract from a report of the Chicago 
Department of Health gives an idea of what may 
be accomplished in school dental dispensaries: 

"The Department of Health maintains thirteen 
dental dispensaries situated in the public schools. 
These dispensaries are operated during school hours 
and on school days by licensed dentists who have 
passed the civil service examination. The cases 



SPECIAL FEATURES 69 

are brought to the dispensaries by the school nurses, 
who first procure the consent of the parents for den- 
tal treatment, and by a call at the home satisfy 
themselves that the case cannot possibly be taken 
care of by the parents. 

"Statistics show that 300,000 school children in 
Chicago have defective teeth. Our clinics have 
cared for an average of 10,000 children per year. 
With new pupils starting in the schools each year, 
we are impressed with the necessity of the expansion 
of our dental service. The average co^ of putting 
a child's mouth in order at our dental clinics is 
$1.45f. This includes salaries, material, and re- 
pairs of equipment. 

" Children present themselves at the dental clinics 
with mouths full of abscessed and decayed teeth, 
the breeding places of infectious diseases. Chil- 
dren with low mentality have been watched after 
their teeth have been put in order and a definite 
mental progress has been noted. If a child does 
not advance to a higher grade after a year's educa- 
tion, the $42.38, the average cost of a year's educa- 
tion, is a dead loss to the city, inasmuch as the child 
must remain in the same grade. Why not spend the 
money in dental education and treatment, and 
produce results?" 



70 handbook for school nurses 

Toothbrush Drills 

Nurses sometimes make the mistake of supposing 
that because a child has a toothbrush he knows 
how to use it, while as a matter of fact, the evidence 
shows that very few children really brush their 
teeth properly. To supply the necessary knowl- 
edge on this important subject, toothbrush drills 
have been introduced into the schools in many of 
our cities with excellent results. It is well to take 
a small group of children at a time for this drill, 
so that each will receive individual instruction, as 
well as the class drill. 'WTien a group is skilled in 
the movements, an exhibition drill may be given 
before the whole class. The following method of 
brushing the teeth is given by Dr. A. P. Baur, 
Supervising Dentist, Chicago Department of Health. 

Proper Procedure for Brushing Teeth 

For convenience, divide surfaces to be brushed 
into four parts : 

1. Outer Surfaces, Upper and Lower Teeth. 

Place brush on inside of upper left cheek, and 
nearly close teeth together. Direct brush backward 
and downward, then upward and forward, making 
a complete circle. Do this rapidly and lightly, to 
stimulate the gums. Use this same motion on the 



SPECIAL FEATURES 71 

teeth of the left side, on the front teeth, and on the 
teeth of the right side, reversing the motion on the 
right side if more convenient, and taking care to 
reach all the teeth. Teeth should not be brushed 
crosswise on these surfaces. 

2. Inside Surfaces, Upper Teeth. 

Hold brush with tufts pointing upward, use fast 
in-and-out stroke, reaching as far back on gums as 
possible, and brushing the roof of the mouth and 
the upper surface of the tongue. 

3. Inside Surfaces, Lower Teeth. 

Hold brush in fist with thumb lying on back of 
handle. Use mostly tuft end, with light in-and-out 
motion, reaching all surfaces of teeth and gums. 
Be sure to reach gums back of last lower, back teeth. 

4. Chewing Surfaces. 

Brush all chewing surfaces of teeth, both upper 
and lower, so as to remove all food from the grooves 
and pits. Use light in-and-out motion. 

Fresh Air Schools 
Fresh air schools, or open window rooms, are 
maintained to some extent in most cities, for the 
benefit of ansemic and under-nourished children 
whose physical condition is such as to make attend- 
ance in the ordinary classroom a menace to their 



72 HANDBOOK FOR SCHOOL NURSES 

future welfare, children who need more and better 
food than can be provided at home, and who require 
frequent rest periods during the day. 

One of the most encouraging features of the fresh 
air room is found in the fact that the children be- 
come so accustomed to pure air in the school that 
they insist upon having the windows open at home, 
thus benefiting the entire family. Children are 
usually most anxious to report to the teacher and 
the nurse the fact that they keep the windows open 
at home. 

In view of the fact that fresh air rooms have 
proved beneficial for under-nourished children, it 
is strange that the same principle is not applied to 
normal children, making all classrooms fresh air 
rooms. 

Following is the daily program of the fresh air 
classes in the Milwaukee schools: 

8 : 30 to 9 : 00 Preparation. 

9 : 00 to 9 : 20 Lunch — toothbrush drill. 

9 : 20 to 10 : 00 Spelling. 
10 : 00 to 10 : 30 Reading, grades 5 to 8. 
10 : 30 to 11 : 00 Arithmetic, grades 5 to 8. 
11 : 00 to 11 : 30 Reading and Arithmetic, grades 1 to 4. 
11 : 30 to 12 : 00 Physical exercise, games, and getting 

ready for dinner. 
12 : 00 to 1 : 00 Dinner, toilet, and brushing teeth. 



SPECIAL FEATURES 73 

1:00 to 2:30 Preparing for bed, rest, putting beds 
and blankets away. 

2 : 30 to 3 : 00 Finish work done in a.m. 

3 : 00 to 3:15 Penmanship when weather permits. 

In winter clothes are changed and put 
away. 
3 : 15 to 3 : 30 Lunch and dismissal. 

One morning each week is devoted to hand work, 
which consists of raffia work, basketry with reeds, 
chair caning, sewing and crocheting, and pillow lace, 
the product of this labor being sold. The girl who 
makes the lace receives half of the proceeds, the 
other half being turned over to the school for run- 
ning expenses. 

Diet List : Milwaukee Fresh Air Schools 

Protein Requirements of Children 6-10 Years of 

Age 

Child 6 years of age : 
Assumed weight, 44 lbs. 
Protein, 50-60 grams. 
1650 Calories. 

Child 8-10 years of age : 
Assumed weight, 60 lbs. 
Protein, 60 grams. 
1760 Calories. 

Child 10-12 3^ears of age : 
Assumed weight, 80 lbs. 



74 handbook; for school nurses 

Protein, 70 grams. 
1800 Calories. 
Serve milk at every meal when cocoa is not on the menu. 

Cekeals 

Farina. 
Cornmeal. 
Crushed wheat. 
Crushed barley. 
Hominy. 
Oatmeal. 

Monday 

Breakfast : 

Cream of wheat, milk, and sugar. 

Toast. 

Cocoa. 
Dinner : 

Pot roast. 

Mashed potatoes. 

Tomatoes. 

Custard. 

Bread and butter. 

Milk. 
3:20: 

Graham crackers. 

Milk. 

Tuesday 
Breakfast : 

Sliced oranges. 
Oatmeal, milk, sugar. 
Bread and butter. 



SPECIAL FEATURES 75 

Dinner : 
Thick vegetable soup. 
Rice and tomatoes. 
Vanilla cream pudding. 
Bread and butter. 
Milk. 

8:20: 
Graham crackers. 
Milk. 

Wednesday 
Breakfast : ^ 

Hominy, cream, sugar. 
Milk. 
Bread and butter. 

Dinner : 

Beef stew with potatoes. 
Peas and carrots. 
Stewed apricots. 
Bread and butter. 
Milk. 

8:20: 

Peanut butter sandwiches. 
Milk. 

Thursday 

Breakfast: 
Apple sauce. 

Cornmeal mush, milk, sugar. 
Bread and butter. 
Cocoa. 



76 HANDBOOK FOR SCHOOL NURSES 

Dinner : 

Thick potato soup. 
Hashed beef. 
Stewed corn. 
Soft custard. 
Bread and butter. 
Milk. 

S:20: 

Saltines. 
Milk. 

Friday 

Breakfast : 

Cracked wheat, milk, sugar. 

Bread and butter. 

Cocoa. 
Dinner : 

Scrambled eggs. 

Mashed potatoes. 

Bread pudding. 

Bread and butter. 

Milk. 

S:W: 
Jelly sandwiches. 
Milk. 

Monday 

Breakfast : 
Milk toast. 
Graham crackers. 
Cocoa. 



SPECIAL FEATURES 77 

Dinner : 

Beef soup with vegetables. 

Mashed potatoes. 

Baked apples. 

Bread and butter. 

Milk. 
8:20: 

Peanut sandwiches. 

Milk. 

Tuesday 
Breakfast : 

Stewed prunes. 

Oatmeal, milk, sugar. % 

Bread and butter. 

Cocoa. 
Dinner : 

Thick split pea soup. 

Poached eggs on toast. 

Farina pudding. 

Milk. 
3:20: 

Milk and crackers. 

Wednesday 
Breakfast : 

Cracked wheat, cream, sugar. 

Soft boiled egg. 

Bread and butter. 

Milk. 

Dinner : 

Hamburger steak. 

Creamed potatoes. 



78 HANDBOOK FOR SCHOOL NURSES 

Stewed apricots. 
Bread and butter. 
Milk. 
S:20: 
Milk. 
Graham crackers. 

Thursday 
Breakfast : 

Sliced oranges. 

Hominy, cream, sugar. 

Bread and butter. 

Cocoa. 
Dinner : 
' Lamb stew with vegetables. 

Rice or mashed potatoes. 

Sponge cake. 

Bread and butter. 

Milk. 
S:20: 

Saltines. 

Hot milk. 

Friday 

Breakfast : 

Cornmeal mush, milk, sugar. 
Hot milk. 
Bread and butter. 
Dinner : 
Scrambled eggs. 
Creamed potatoes. 
Stewed tomatoes. 
Rice pudding with fruit sauce. 



SPECIAL FEATURES 79 

Bread and butter. 
Milk. 

S:20: 
Cup cake or crackers. 
Milk. 

Monday 

Breakfast: 

Apple sauce. 
Creamed toast. 
Hot cocoa. 

Dinner : 
Meat loaf. ^ 

Creamed carrots. 
Mashed potatoes. 
Apple bread pudding. 
Bread and butter. 
Milk. 

S:20: 
Crackers and milk. 

Tuesday 
Breakfast: 
Cream of wheat, milk, and sugar. 
Bread and butter. 
Cocoa. 

Dinner : 
Thick vegetable soup. 
Boiled onions. 
Bread and butter. 
Baked apples with cream. 
Milk. 



80 HANDBOOK FOR SCHOOL NURSES 

S:W: 
Milk. 
Graham crackers. 

Wednesday 

Breakfast : 
Sliced oranges. 

Oatmeal porridge, milk, sugar. 
Bread and butter. 
Cocoa. 

Dinner : 

Baked chopped meat patties. 

Potatoes with parsley. 

Creamed celery. 

Cup custard. 

Bread and butter. 

Milk. 

S:^0: 

Salted wafers. 
Milk. 

Thursday 
Breakfast : 

Cornmeal porridge, milk, and sugar. 

Bread and butter. 

Milk. 

Dinner : 
Beef stew. 
Mashed potatoes. 
Tomatoes. 
Bread and butter. 



SPECIAL FEATURES 81 

Stewed prunes and gingerbread. 
Cocoa. 
3:20: 
MUk. 

Friday 

Breakfast : 

Boiled rice with milk and sugar. 
Bread and butter. 
Cocoa. 
Dinner : 

Creamed salmon. 

Mashed potatoes. 

Lima beans with butter sauce, or peas. 

Bread and butter. 

MHk. 

Floating island and cup cakes. 

3:20: 
Milk. 
Graham cookies. 

Monday 

Breakfast : 

Oatmeal porridge, with milk and sugar. 

Bread and butter. 

Cocoa. 
Dinner : 

Creamed dried beef on toast. 

Potatoes with parsley. 

Buttered peas. 

Bread and butter. 

Milk. 

Apple sauce. 



82 HANDBOOK FOR SCHOOL NURSES 

3:20: 

Oatmeal cookies. 
Cocoa. 

Tuesday 

Breakfast : 

Cornmeal porridge, with milk and sugar. 

Bread and butter. 

Cocoa. 
Dinner : 

Boston baked beans. 

Boston brown bread and milk. 

Cored baked apples with cinnamon, sugar, 
and cream. 
3:W: 

Bread and butter. 

Milk. 

Wednesday 
Breakfast : 

Cream of wheat with cream and sugar. 

Buttered brown bread. 

Cocoa. 
Dinner : 

Scrambled eggs on toast. 

Escalloped corn. 

Bread and butter. 

MHk. 

Stewed apricots. 
3:20: 

Milk. 

Saltines. 



special features 83 

Thursday 
Breakfast: 
Stewed fruit. 
Hot milk toast. 
Cocoa. 

Dinner : 
Beef loaf with brown pan gravy. 
Mashed potatoes. 
Bread and butter. 
Milk. 
Prune whip. 

S:20: % 

Graham crackers. 
Milk. 

Friday 

Breakfast : 
Boiled rice with cream. 
Bread and butter. 
Cocoa. 

Dinner : 

Sardine paste sandwiches. 

Creamed potatoes. 

Buttered peas. 

Bread and butter. 

Milk. 

Chocolate corn starch pudding.* 

8:20: 
Milk. 
Cup cakes. 



84 handbook for school nurses 

The School Nurse as an Attendance Officer 

Should the school nurse add to her other activities 
the work of the attendance, or truancy, officer, or 
should she retain only the altruistic function, leav- 
ing the detection and correction of truants and 
other absentees to another officer? 

The qualities that enter into the makeup of a 
good school nurse would, beyond question, make of 
her the ideal attendance officer, but whether she 
would be as welcome in the homes of her district 
if she came in the capacity of a detective, and whether 
or not she would win and hold the confidence of 
the people as she does when she comes in her purely 
nursing capacity, is a very large question. One 
nurse who did this work for a time says : "A nurse 
always sees some condition in the family, or the 
child, that may be a possible cause for truancy ; and 
so has something to work on that really interests 
the family and takes the sting out of her seeming 
interference. Her interest in the physical welfare 
of the family and her timely suggestions for im- 
proving the health of its members makes of an 
unwelcome official an appreciated visitor, who is 
usually asked to call again." ^ 

Undoubtedly the day is not far distant when the 

^ Amy F. Lowe, Paducah, Ky. 



SPECIAL FEATURES 85 

two functions will be combined in the office of the 
school nurse, at least in smaller communities, and 
it is hoped that the better attendance will compen- 
sate for a possible loss of the confidence now placed 
in the nurse by the people in her district. 

Cooperating Agencies 
In the course of her visits to the home the nurse 
often meets problems which will require the assist- 
ance of other agencies for their solution. There 
may be unsanitary conditions of the hou§e or yard, 
financial stress, illness, unemployment, irregular 
social relations, or some other condition calling for 
prompt action if the integrity of the family is to 
be preserved. Here is where a thorough knowledge 
of the location and fimction of the various relief 
agencies will be valuable as a means of saving time 
and preventing undue suffering and deprivation. 
' There is, probably, no greater test of a nurse^s 
breadth of vision and interest in the welfare of her 
children than the manner in which she cooperates 
with the other social workers in her district. She 
must be able to recognize the fact that no one in- 
dividual or organization can contain the sum total 
of human knowledge, or human ability, that the 
medical worker should not dispense material rehef, 
and that there is plenty of work for all. 



86 handbook; for school nurses 

Principal Cooperating Agencies Usually Found 

IN Cities 

1. County provides food; fuel, medical care, and 
admission to the county institutions, administers 
funds to parents, and widows' pensions, also main- 
tains Juvenile and Domestic Relations Courts. 

2. United Charities supplies food, clothing, rent, 
employment, friendly advice, moral support, in- 
struction in home making. 

3. Church Organizations: St. Vincent de Paul 
Society, Hebrew Charities, etc., — food, clothing, 
rent, fuel, employment, medical care, friendly 
visitors, moral support. 

4. Fraternal Organizations: Employment, mate- 
rial relief, moral support. 

5. Juvenile Court: Hears cases of delinquent and 
neglected children, advises parents, places children 
on probation or commits them to institutions. 

6. Visiting Nurse Association: Cares for the 
sick in their homes. Teaches home sanitation and 
home care of the sick. 

7. Infant Welfare Society: To keep the baby 
well. Instructs mothers in the care and feeding 
of infants. 

8. Anti4uherculosis Society: Disseminates knowl- 



SPECIAL FEATURES 87 

edge on the prevention of tuberculosis. Provides 
instruction and care for those already infected. 

9. Hospitals and Dispensaries: Treat children 
who are in need of medical or surgical attention. 
Give free care to those whose parents cannot afford 
to pay for treatment. 

10. Physicians and Dentists: Care for children 
at their offices and give advice on matters of per- 
sonal hygiene and prophylaxis. 

In Small Towns 

The Town Coimcil or Village Board, the School 
Board, Medical Societies, Women's Clubs, Civic 
Clubs, Charity Organizations, Church Organiza- 
tions, the American Red Cross Town and Country 
Nursing Service. 

In Rural Communities 

County Boards, County Medical Societies, Anti- 
tuberculosis Societies, Granges, American Red 
Cross Town and Country Nursing Service, Church 
Organizations. 



CHAPTER VI 

COMMUNITY NURSING : PROBLEMS — SURVEY — 
CONFERENCES — HOME CALLS — CORRECTION 
OF PHYSICAL DEFECTS 

In rural communities and in the smaller towns 
which cannot afford the services of speciaHsts, the 
pubhc health nurse will probably be known as the 
conmiunity nurse^ or the county nurse. In either 
case she must combine the functions of school and 
visiting nurse with those of the infant welfare and 
tuberculosis worker, must be, in short, the sentinel 
guarding the community health. 

Because of the distances to be covered, the com- 
munity nurse will not be able to give bedside care, 
except in extreme cases which cannot be cared for 
otherwise. Her function in the community must, 
in the nature of things, be largely advisory and edu- 
cational. For this reason it is necessary that the 
community nurse be a good teacher, one who not 
only knows the solution of health problems, both 
public and private, but who also has the faculty of 
imparting this knowledge, in usable form, to others. 



COMMUNITY NURSING 89 

She must be able to demonstrate clearly, to the 
mothers, the various procedures of household hy- 
giene and of home nursing ; to impress the fathers 
with the importance of proper hygienic conditions 
in schools, churches, and other pubHc meeting 
places; and finally to convince the local author- 
ities of the fact that money spent for health is well 
invested. 

When the community nurse has won the confi- 
dence of the people in her district, shS can do a 
great deal toward helping them solve the problem 
of proper food, not only for the children, but for the 
whole family. 

Home calls will be necessary in many instances 
in order to call the attention of the parents to the 
necessity for having physical defects corrected, and 
how this correction may best be secured, the pre- 
cautions to be observed in contagious diseases, and 
the treatment for pediculosis. 

The nurse should be interested in all the com- 
munity activities, and should always be ready to 
give the benefit of her knowledge and experience 
in every movement for the improvement of living 
conditions, and willing to cooperate with all agencies 
working for community good. 

The community nurse should not give material 



90 HANDBOOK FOR SCHOOL NURSES 

relief, because by so doing she stamps herself as 
an almsgiver, and as such fails to reach many people 
who would be glad of her assistance if it were not 
charity. It is always possible to relieve distress, 
when necessary, through some other agency. 

School nursing is a very important phase of 
community health work, as the interest of parents 
is more readily aroused through the children than 
by a direct appeal. For this reason the first step in 
a community health campaign might well be a sur- 
vey of conditions in the schools, noting the children 
who appear to be suffering from phj^sical defects or 
contagious conditions, and those who are ansemic 
or under-nourished. 

In the country the schools are usually far apart, 
and unless the nurse has a car, or a horse, much 
time must be consumed in follow-up work, unless 
the parents can be induced to \dsit the schools for 
consultation with the nurse and teachers on the 
physical condition of their children and the ways 
and means of having defects corrected. 

These school conferences should be welcomed by 
the nurse as affording an opportunity for advising 
the mother as to the selection and preparation of 
food for the children, especially school lunches. 
There is a common belief that country children are 



COMMUNITY NURSING 91 

always well fed, but a very limited observation will 
prove that as many children are under-nourished in 
the country as in the city, and this not because of 
poverty, but because of lack of knowledge of the 
fundamental principles of foods and nutrition. 

The problem of securing the correction of physical 
defects found in the poor children of rural districts, 
may sometimes be met by interesting the chiefs of 
dispensary staffs in the nearest town with a teach- 
ing hospital, or a medical school. Clinicians are 
usually glad to care for these children, particularly 
as they often present interesting and unusual 
cases for their students. 

The plan followed in caring for physically defec- 
tive children in Kewanee, Illinois, presents so many 
excellent features that it is given here in detail. 

"In Kewanee, school nursing was started by the 
Women's Club, which paid the salary of the Civic 
Nurse. The interest of the local physicians was 
secured and a dispensary started in a vacant house, 
about twenty physicians giving their services for 
one hour weekly, taking their turn in alphabetical 
order. Twelve dentists also contributed their serv- 
ices, holding two dental clinics each week at the 
dispensary. Following is the plan followed in the 
care of children suffering from physical defects: 



92 HANDBOOK FOR SCHOOL NURSES 

"1. Any child who seems below normal, who 
shows definite symptoms of disease, or who is in 
need of a general clean-up may be sent by the 
principal, as a matter of regular school requirement, 
to the North Side Dispensary for a preliminary 
examination. 

"2. The physicians of the city will serve in rota- 
tion as Dispensary physician for this examination. 

"3. A dental clinic will be held twice a week. 

"4. The Civic Nurse will be at the Dispensary 
daily, except Saturday and Sunday, from 4 : 15 to 
5 : 15, at which time the doctors and dentists will 
make the examination. She will do the follow-up 
work in the homes to see that suggestions are 
carried out. 

"5. All services rendered at the Dispensary shall 
be free of charge, and given to all school children 
irrespective of home conditions. 

"6. Each child shall be encouraged to go to his 
family physician or dentist, if found to be needing 
more than inmiediate care. 

"7. Cases which are unable to pay for medical 
treatment shall, upon consent of parent or guardian, 
be given to the county physician. 

"8. There will be no physician in regular attend- 
ance at the Dispensary, Saturdays, but children 



COMMUNITY NURSING 93 

needing dressings et cetera may come at the regular 
Dispensary hom-s, 10 to 12 a.m. 

"As the work progressed some changes seemed 
advisable. Obvious eye cases reported Thursday 
afternoons, an eye specialist conducting all exami- 
nations. Provision was made for glasses for needy 
cases through the Central Welfare Council and home 
investigations were made by the nurse. 

" Dental care is given free of charge to needy cases 
by the dentists, both as to immediate care and fol- 
lowing treatment. ^ 

" Emergencies are cared for at the school buildings 
when possible. Minor injuries are sent to the Dis- 
pensary for care." ' 

Attention is called to the fact that all children 
are entitled to free care at the Dispensary, thus elimi- 
nating the charity feature, preserving the self- 
respect of the people, and preparing the way for 
compulsory health, as a prerequisite for compulsory 
education.! 



CHAPTER VII 

RECORDS: THE IMPORTANCE OF COMPLETE 
RECORDS — FORMS 

No matter how limited the activities in the schools 
may be, a careful, complete record should be kept 
of all work done. 

These records are important : 

1. As a means of furnishing statistics with 
which to impress upon county and municipal 
authorities the importance of appropriating funds 
for carrying on the work. 

It is a well-known fact that figures are more con- 
vincing than words, no matter how forcibly the 
latter may be used. Directors and nurses may plead 
indefinitely with the local authorities to appropri- 
ate funds for school inspection, urging the general 
welfare of the children, without obtaining results, 
but when they can produce "documentary evidence'^ 
in the shape of records of inspections actually made 
in the schools, showing that over ninety per cent 
of the children have defective teeth, that between 
fifty and sixty per cent are suffering from imperfect 

94 



RECORDS 95 

vision, that thirty to forty per cent are handicapped 
by diseased tonsils, or adenoids, or both, and that 
a large percentage are affected with contagious skin 
diseases, then there is no chance to evade the facts, 
and usually there is no desire to do so, as the need 
of the child, when shown to exist, makes a strong 
appeal to the average man. 

2. To furnish a record of the child^s physical 
condition for the benefit of the school authorities. 
As the intellectual progress of the child depends 
largely upon his physical condition, it is important 
that the teacher be kept informed as to the health 
of the children in her class, particularly those known 
as backward or " retarded '' pupils, to the end that 
she may adjust the school work to the physical 
capacity of the child and also lend her influence to 
securing treatment for the correction of defects. 

3. To facilitate the entry of the child into the 
high school or the industrial world, as the case 
may be, when he leaves the grammar school. Most 
schools for higher education, and an increasing 
number of business firms, require certificates of 
vaccination and a contagious disease history from 
appHcants for employment. The school physical 
record card will furnish this information, also data 
concerning correction of physical defects, such as 



96 HANDBOOK FOR SCHOOL NURSES 

visual and aural conditions, which might interfere 
with the child^s usefulness in certain fields. Thou- 
sands of boys and girls enter the business world 
each year handicapped at the start by inadequate 
preparation because of some physical condition 
which interfered with their progress in school. 
For this reason alone, it would seem that medical 
inspection of schools should be as much a function 
of the state as is their educational supervision. 
We should have, and in the not distant future shall 
have, compulsory health, as well as compulsory edu- 
cation, for our citizens in the making. 

4. For the information of the nurse who may 
be called upon to take up the work temporarily, or 
permanently, because of the resignation, illness, 
or death of the school nurse. Nurses are no excep- 
tion to the natural law of change ; indeed we might 
be considered as being, next to the weather, its 
greatest exponent. Because of the ever increasing 
demand from above, and the insistent pressure 
from below, the nurse who is properly equipped is 
constantly moving up, her place being filled 
from the rank just below ; and there are few of her 
predecessor's virtues which the nurse in a new posi- 
tion will appreciate as much as the keeping and fil- 
ing of complete records, and there are few things 



RECORDS 97 

more trying than to follow a nurse — no matter 
how excellent otherwise — who has failed to leave 
full records of work accomplished or begun. 

5. Such records are a valuable contribution to 
nursing history. For many years nurses have 
been willing to have their work recorded only in 
the Book of Life, striving for better conditions for 
nurses and others with a quiet devotion and an 
aversion to publicity which have stamped our 
profession with some of its most striking and most 
admirable characteristics. Now, however, a later 
generation of nurses is asking about the work and 
lives of these pioneers, and there is little information 
available. Coming generations of school nurses 
will wish to know how school nursing was carried 
on in its pioneer days, and only by keeping careful 
records of our work from day to day shall we be 
able to fulfill our obligation to the future. 

The emphasis laid upon the importance of ade- 
quate records should not mislead the nurse into 
believing that recording the results of her work is 
more vital than the work itself, or more important 
than her own proper rest and recreation. Many 
nurses spend hours at home making reports and 
keeping up records, when they might better spend 
that time in rest or recreation. The same good 



98 HANDBOOK FOR SCHOOL NURSES 

sense and judgment should enter into the keeping 
of records as is exercised in the performance of the 
work. All non-essentials should be carefully elimi- 
nated, and only such facts as have a direct bearing 
upon the welfare of the child should be recorded. 

Whenever possible, the records and reports should 
be written up in the schools, or at least during the 
nurse's hours on duty, leaving the evenings free for 
her own affairs. When the clerical force is ade- 
quate, the monthly reports and summaries should 
be compiled in the central office, reserving the 
nurse's time and energy for the activities in the 
field. 

The form of record used will depend largely on 
local conditions and on the organization directing 
the work, as Boards of Health usually require more 
detail in the history of contagious diseases, the 
vaccinal status, etc., than do Boards of Education, 
and where the work is administered by still other 
agencies, emphasis may be laid on other data. 

There are certain fundamentals, however, which 
must be embodied in all physical records if they are 
to be of statistical value. These will be readily 
seen by referring to the forms used in the Milwaukee 
schools, where the work is directed by the Board of 
Education, and those used in Chicago, where the 



RECORDS 99 

medical inspection is carried on by the Department 
of Health. 

There are many other forms in use in the schools 
of Milwaukee and of Chicago for notifications, 
reports, and records, but as local conditions must 
determine, to a large extent, the forms used in any 
community, only the Physical Record, and Dental 
blanks are shown here, as it is possible to standardize 
these forms. The Physical Record card is — or 
should be — sent with the child when%he is pro- 
moted to a higher grade, when he goes to another 
school in the same town, when he goes to a school 
in another town, and finally is given to him when 
he leaves the grade school, when it facilitates his 
entrance to the High School or the business world, 
as circiunstances decide. For the other forms and 
blanks used in the schools, it is wise when beginning 
the work, to secure copies of the forms used in cities 
or towns of equal size and like character and adapt 
them to the local situation. 



NAME DEPARTMENT OF HEALTH Address 

CITY OF CHICAGO 


PHYSICAL 

Card N*^.. — 


RECORD 










10 Sex 10 Color 


11 Birthplace | 


Nationality of Father 12-13 Mother 


15 No. of Children in Fanaily His. of Measles 


Diph. Pertussis Pneu. Scar. Fever 


5-7 School 16 Class 48 *Vaccinated? 


Date 1st. Exam. 19 14 Attendance 


O Placed in square means absence of Defects. X Denotes Defects 


16 Grade 


1 


2 


3 


4. 


5 


6 


7 


8 


8-9 Date of Physical Exam. 


















17 Age at Examination 


















18 Age starting School 


















19 Years in School 


















Diseases during the year 


















20 Height 


















20 Weight 


















21 Nutrition 


















22 Anaemia 


















23 Enlarged Lymph Glands 


















24 Enlarged Thyroid 


















25 Nervous Diseases 


















26 Cardiac Disease 


















27 Pulmonary Tuberculosis 


















28 Other Pulm. Diseases 


















29 Skin Disease 


















30 Rachitic Type 


















31 Other Orthopaedic 


















32 Defect of Vision 


















33 Other Diseases of Eyo 


















34 Defect of Hearing 


















35 Discharging Ear 


















36 Defect of Nasal Breathing 


















37 Defect of Palate 


















38 " " Teeth 



















39 Hypertrophied Tonsils 


















40 Adenoids 


















41 Tonsils and Adenoids 


















42 Was treatment advised 


















43 Mentality 


















44 Conduct 


















45 Promotion 


















46 EflTort 


















47 Proficiency 


















48 •Bevaccination 






















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Physical Record 
Name Rrlir.nl 


Surname Given Name 
Sex Birthplace 


TRANSFERS 


History of Measles Diphth 


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1 


DATE 


SCHOOL 


is 




































School Year 


I 


2 


3 


4 


5 


6 


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9 


Grade 


















Age of Child 








































Diseases during term . 








































Height 








































1 Nutrition 








































3 Adenoids 




















4 Def . Nasal Breathing . 




















5 Defective Palate 




















6 Defective Teeth 




















( R-. 




















7 1 Myopia { 
' Deffctive) < L. 




















5^ Vision ) 

^ ^ Hypermetrop. 




















9 Other Eye Defect... 




















10 Defective Hearing... 




















11 /Spine . . 




















12 Orthopedic .< Trunk. . 




















13 VExtrem. 




















14 Enlarg. Lymph Nodes 




















15 Pulmonary Disease . . 




















16 Cardiac Disease 




















17 Nervous 




















IS Chorea 




















19 Epilepsy 




















20 Stammer 








































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INDEX 



A 

Adaptability, 27 
Adenoids, 37, 46 
Administration, 7 
American Red Cross, 87 
Anti-tuberculosis Society, 86 
Assignments, 13 
Attendance Officer, 84 
Authority, 1, 13 



Baby, 43, 53, 56 

Bag, 22 

Bandages, 60 

Bathing, 57 

Beds, 56 

Board of Health, 5, 6, 7, 8, 26 

Boards of Education, 4, 6, 7, 8, 26 

Boyd, Mrs. Francis, 4 



Calls, 30, 37, 41, 43, 92 
Cards : 

Colored, 37 

Consent, 36 

Physical Record, 36, 95, 99 
Care of the baby, 53, 56, 59 
Causes of high infant death rate, 59 
Central Welfare Council, 93 
Church Organizations, 86 
Cleanliness, 43, 51, 56 
Clinics, psychological, 6 
Clothing, 51, 57, 65 
Clubs : 

Boys', 63 

Little Mothers', 53 
Conferences, School, 90 
Contagion, 33 
Contagious Skin Diseases, 2, 10, 31, 

33, 34, 38, 39 
CoSperating Agencies, 85 
Cooperation, 25, 85, 89 
Courts, 37, 86 
Cultures, 38 



Daily Inspections, 31, 35 

Defects, Physical, 37 

Dental Dispensaries, 5, 67, 92 

Dentists, 87 

Diet, 43 

Diet lists, 73 

Director of School Hygiene, 6 

Disease Carriers, 56 

Dispensaries : 
Dental, 5, 67, 92 
General, 37, 44, 87, 92 

Dressings, 38, 39 

E 

Education, 17, 51, 65, 86 
Emergencies, 36, 38, 61, 93 
Equipment, 23 
Ethics, 16, 23 
Evening work, 9 
Examinations, 9, 36 
Exclusions, 2, 10, 31 
Exercise, 52 



Family History, 36 

Family Physician, 10, 33, 36, 37, 

44, 87, 92 
Favus, 40 
Field Nurse, 16 
First Aid, 60 
Follow-up Work, 9 
Food, 51, 58, 65, 73, 83 
France, 1 

Fraternal Organizations, 86 
Free Treatment, 44 
Fresh Air Schools, 71 

G 

Girls' Health Leagues, 63 

H 



Habits, 19 
Handbag, 22 



X07 



108 



INDEX 



Health, 18, 51, 93, 96 

Health Advisor, 5 

Health Boards, 5, 6, 7, 8, 26 

Health Leagues, 53 

Health Officer, 25, 33 

History, 1, 97 

Home Calls, 30, 37, 41, 45, 89 

Home Sanitation, 56 

Hospitals, 45, 87 

Hours, 28 

I 

Ideal School Nurse, 20 
Impetigo, 39 
Indifferent Parents, 37 
Infant Welfare, 43, 53, 86 
Injuries, 61 
Inspections : 

Daily, 31, 35 

Preliminary, 34 

Routine, 35 
Instruction, 52, 53, 89 



Juvenile Courts, 86 



Kewanee, 111., 91 

Knights of the Canvas Bag, 64 



Lecturer, 5 

Little Mothers' Clubs, 63 

London, 3 

M 

Material Relief, 87 
Misunderstandings, 27 
Modification of Milk, 53 
Morton, Miss Honnor, 2 

N 
Newsboys, 63 
Nurses' Handbag, 22 
Nurse working alone, 11, 18, 32 



Organization, 7 
Organizations : 

Church, 86 

Civic, 66 

Fraternal, 86 



O 



Outline of Little Mothers' Club 
Work, 55 

P 

Parents, 37, 44 

Parent-Teachers' Associations, 65 

Parochial Schools, 4, 8, 54 

Pauperization, 44 

Pediculosis, 31, 40 

Personal Habits, 19 

Physical Defects, 8, 32, 37, 47, 92 

Examinations, 36 

Records, 36, 95, 99 
Physician, 10, 33, 36, 37, 44, 92, 93 
Preliminary Inspections, 34 
Prevention, 33 
Principal, 26, 30, 38, 41 
Private Schools, 4, 8 
Protein Requirement, 73 
Psychological Chnics, 6 



Quarantine, 33 



Q 



R 



Readmissions, 30 
Records, 94 
Red Cross, 87 
Relaxation, 12 
Responsibility, 8, 13, 14 
Rest, 52, 65 
Ringworm, 34, 39 
Routine Inspections, 36 
Routine Talks, 51 

S 

Salaries, 11 
Scabies, 34, 40 
School Clinics, 38 
School Conferences, 90 
School Treatments, 36 
Schools : 

Parochial, 4, 8 

Private, 4, 8 

Rural, 90 
School Work, 9 
Settlement, Henry Street, 3 
Shoes, 22 
Signals, 30 
Signs of iUness, 60 



INDEX 



109 



Skin Diseases, 2, 10, 31, 33, 34, 38, 

39 
Social Hygiene, 5, 32, 52 
Statistics, 94 
Stretcher, 61 
Stnithers, Mrs. W. E., 3 
Superintendent of Nurses, 13 
Supervising Nurses, 15 
Supplies for Bag, 22 



Teeth, 5, 37, 46, 51, 69, 70 
Tonsils, 37, 46 
Toothbrush Drills, 70 
Treatments, 6, 36 
Truancy, 2, 63 



U 

Uniforms, 20 
United Charities, 86 

V 

Vacations, 12, 34 
Vaccinations, 37 
Ventilation, 43, 51, 72 
Vision, 37, 46 
Visiting Nurses, 2, 3, 4 

W 

Wald, Miss LilHan, 3 

Women's Clubs, 4, 7, 66, 68, 87, 91 

Working Mothers, 37 



Printed in the United States of America. 



npHE following pages contain advertisements of 
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Public Health Nursing 

{Y MARY S. GARDNER, R.N. 



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